Collège universitaire de médecine générale, Université Claude Bernard Lyon 1, F-69008 Lyon, France
Unité d'Evaluation Médico-Economique, Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France; and RESHAPE Inserm U1290, Université Claude Bernard Lyon 1, F-69008 Lyon, France
Rural Remote Health. 2021 Sep;21(3):5865. doi: 10.22605/RRH5865. Epub 2021 Sep 1.
In various countries, a shortage of general practitioners (GPs) and worrying health statistics on risk factors, morbidity and mortality have been observed in rural areas. However, few comparative data are available on GP activities according to their location. The aim of this study was to analyse French GP activities according to their rural or urban practice location.
This study was ancillary to the Eléments de la COnsultation en médecine GENérale (ECOGEN) study, which was a cross-sectional, multicentre, national study conducted in 128 French general practices in 2012. Data were collected by 54 interns in training during a period of 20 working days from December 2011 to April 2012. GP practice location was classified as rural area, urban cluster or urban area. The International Classification of Primary Care (ICPC-2) was used to classify reasons for encounter, health problem assessments, and processes of care. Univariate analyses were performed for all dependent variables, then multivariable analyses for key variables, using hierarchical mixed-effect models.
The database included 20 613 consultations. The mean yearly number of consultations per GP was higher in rural areas (p<0.0001), with a shorter consultation length (p<0.0001). No difference was found for GP sex (p=0.41), age (p=0.87), type of fees agreement (p=0.43), and type of practice (p=0.19) according to their practice location. Urban patients were younger, and there was a lower percentage of patients over 75 years (p<0.001). GPs more frequently consulted at patients' homes in rural areas (p<0.0001). The mean number of chronic conditions managed was higher in rural areas and urban clusters than in urban areas (p<0001). Hypertension (p<0.0001), type 2 diabetes (p=0.003), and acute bronchitis/bronchiolitis (p=0.01) were more frequently managed in rural areas than in urban clusters and areas. Health maintenance/prevention (p<0.0001) and no disease situations (p<0.0001) were less frequent in rural areas. Drug prescription was more frequent in rural areas than in urban clusters and areas (p<0.0001). Multivariable analysis confirmed the influence of a GP's rural practice location on the consultation length (p<0.0001), the number of chronic conditions per consultation (p<0.0001) and the number of health maintenance/prevention situations (p<0.0001), and a trend towards a higher yearly number of consultations per GP (p=0.09).
French rural GPs tend to have a higher workload than urban GPs. Rural patients have more chronic conditions to be managed but are offered fewer preventive services during consultations. It is necessary to increase the GP workforce and develop cooperation with allied health professionals in rural areas.
在不同国家，农村地区都存在全科医生（GP）短缺和令人担忧的风险因素、发病率和死亡率等健康统计数据。然而，关于 GP 活动的比较数据很少，也没有根据其所在地进行分类。本研究旨在根据 GP 的农村或城市工作地点分析其活动情况。
本研究是 Eléments de la COnsultation en médecine GENérale（ECOGEN）研究的辅助研究，该研究是 2012 年在法国 128 家普通诊所进行的一项横断面、多中心、全国性研究。2011 年 12 月至 2012 年 4 月期间，54 名实习医生在 20 个工作日内收集数据。GP 工作地点被归类为农村地区、城市集群或城市地区。使用初级保健国际分类（ICPC-2）对就诊原因、健康问题评估和护理过程进行分类。对所有因变量进行单变量分析，然后对关键变量进行多变量分析，使用分层混合效应模型。
数据库包括 20613 次就诊。农村地区每位 GP 每年的就诊次数较高（p<0.0001），就诊时间较短（p<0.0001）。根据工作地点，GP 的性别（p=0.41）、年龄（p=0.87）、收费协议类型（p=0.43）和工作类型（p=0.19）没有差异。城市患者年龄较小，75 岁以上的患者比例较低（p<0.001）。农村地区 GP 更频繁地到患者家中就诊（p<0.0001）。农村地区管理的慢性疾病数量高于城市集群和城市地区（p<0001）。高血压（p<0.0001）、2 型糖尿病（p=0.003）和急性支气管炎/细支气管炎（p=0.01）在农村地区比在城市集群和地区更常见。健康维护/预防（p<0.0001）和无疾病情况（p<0.0001）在农村地区较少见。农村地区的药物处方比城市集群和地区更频繁（p<0.0001）。多变量分析证实，GP 的农村工作地点对就诊时间（p<0.0001）、每次就诊的慢性疾病数量（p<0.0001）和健康维护/预防情况数量（p<0.0001）有影响，并存在 GP 每年就诊次数增加的趋势（p=0.09）。
法国农村地区的全科医生的工作量往往高于城市地区的全科医生。农村地区的患者有更多的慢性疾病需要管理，但在就诊期间提供的预防服务较少。有必要增加全科医生的劳动力，并在农村地区发展与辅助卫生专业人员的合作。
