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全科医生在 COVID-19 疫情初期如何调整其实践和组织:一项法国全国观察性调查。

How GPs adapted their practices and organisations at the beginning of COVID-19 outbreak: a French national observational survey.

机构信息

Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention, CESP, Villejuif, France

Department of Family Medicine, UVSQ, Faculty of Health Sciences Simone Veil, Montigny Le Bretonneux, France.

出版信息

BMJ Open. 2020 Dec 2;10(12):e042119. doi: 10.1136/bmjopen-2020-042119.

Abstract

OBJECTIVES

To describe how general practitioners (GPs) adapted their practices to secure and maintain access to care in the epidemic phase. A secondary objective was to explore if GPs' individual characteristics and type of practice determined their adaptation.

DESIGN

Observational study using an online questionnaire. Organisational changes were measured by a main question and detailed in two specific outcomes. To identify which GPs' characteristics impacted organisational changes, successive multivariate logistic modelling was performed. First, we identified the GPs' characteristics related to organisational changes with a univariate analysis. Then, we tested the adjusted associations between this variable and the following GPs' characteristics: age, gender and type of practice.

SETTING

The questionnaire was administered online between 14 March and 21 March 2020. Practitioners were recruited by email using the contact lists of different French scientific GP societies.

PARTICIPANTS

The target population was GPs currently practising in France (n=46 056). We obtained a total of 7481 responses.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome: Proportion of GPs who adapted their practice. Secondary outcome: GPs' characteristics related to organisational changes.

RESULTS

Among the 7481 responses, 5425 were complete and were analysed. 3849 GPs (70.9%) changed their activity, 3605 GPs (66.5%) increased remote consultations and 2315 GPs (42.7%) created a specific pathway for probable patients with COVID-19. Among the 3849 GPs (70.9%) who changed their practice, 3306 (91.7%) gave more answers by phone, 996 (27.6%) by email and 1105 (30.7%) increased the use of video consultations. GPs working in multi-professional group practices were more likely to have changed their activity since the beginning of the epidemic wave than GPs working in mono-professional group or single medical practices (adjusted OR: 1.32, 95% CI 1.12 to 1.56, p=0.001).

CONCLUSIONS

French GPs adapted their practices regarding access to care for patients in the context of the COVID-19 epidemic. This adaptation was higher in multi-professional group practices.

摘要

目的

描述全科医生(GP)如何调整其实践以确保和维持在疫情阶段获得医疗服务的途径。次要目的是探讨 GP 的个体特征和执业类型是否决定了他们的适应能力。

设计

使用在线问卷进行观察性研究。组织变革通过一个主要问题进行衡量,并在两个具体结果中详细说明。为了确定哪些 GP 的特征影响了组织变革,我们进行了连续的多变量逻辑建模。首先,我们通过单变量分析确定与组织变革相关的 GP 特征。然后,我们测试了该变量与以下 GP 特征之间的调整关联:年龄、性别和执业类型。

设置

问卷于 2020 年 3 月 14 日至 3 月 21 日在网上进行。通过不同法国科学 GP 协会的联系名单,通过电子邮件向从业者招募。

参与者

目标人群是目前在法国执业的全科医生(n=46056)。我们共收到了 7481 份回复。

主要和次要结果测量

主要结果:调整实践的 GP 比例。次要结果:与组织变革相关的 GP 特征。

结果

在 7481 份回复中,有 5425 份完整回复并进行了分析。3849 名 GP(70.9%)改变了他们的活动,3605 名 GP(66.5%)增加了远程咨询,2315 名 GP(42.7%)为可能患有 COVID-19 的患者创建了专门的途径。在 3849 名(70.9%)改变实践的 GP 中,3306 名(91.7%)更多地通过电话回答问题,996 名(27.6%)通过电子邮件回答问题,1105 名(30.7%)增加了视频咨询的使用。与在单专业团体或单一医疗实践中工作的 GP 相比,在多专业团体实践中工作的 GP 更有可能在疫情爆发以来改变他们的活动(调整后的 OR:1.32,95%CI 1.12 至 1.56,p=0.001)。

结论

法国全科医生调整了他们的实践,以确保在 COVID-19 疫情期间患者获得医疗服务。这种调整在多专业团体实践中更高。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d8e0/7712933/706e284582a7/bmjopen-2020-042119f01.jpg

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