Department of General Practice, Université Paris-Est Créteil, 94000, Créteil, France.
Maison de Santé Universitaire de Sucy-en-Brie, 5 rue Ingres, 94370, Sucy-en-Brie, France.
Hum Resour Health. 2022 May 12;20(1):39. doi: 10.1186/s12960-022-00740-1.
There is an uneven distribution of general practitioners (GPs) across territories of developed countries leading to inequalities in access to health care. Countries are implementing incentive or coercive policies depending on the characteristics of their health system. Several studies suggest that the location of practical training may influence the location of GPs' practices. The objective of this study is to investigate the existence of a relationship between training supervision and evolution of the density of GPs in French municipalities between 2018 and 2021.
The evolution of the density of GPs in almost all French municipalities between 2018 and 2021 was followed up. A bivariate statistical analysis was carried out to look for a relationship between the evolution of the density of GPs and the number of training supervisors. Other bivariate analyses were carried out with other factors likely to influence the density of GPs, such as the existence of financial aid in the territory or the age of GPs. A multivariate analysis with all the significant variables in bivariate analysis was then carried out using the stepwise descending method.
A total of 34 990 (99.9%) French municipalities were included in the follow-up. Among these, 9427 (26.9%) had a GP and 3866 (11%) had a GP involved in the training supervision. The density of GPs in French cities decreased on average by 2.17% between 2018 and 2021. Territories without training supervisors decreased by 4.63% while those with at least one increased by 1.36% (p < 0.01). This significant relationship was also found in multivariate analysis.
The training supervision is associated with a better evolution of density of GPs in French municipalities. This association persisted when other factors were considered. The results of this 3-year follow-up may lead us to consider the training supervision as a factor to regulate the distribution of GPs.
在发达国家，全科医生（GP）的分布不均，导致医疗保健获取方面存在不平等。各国根据其卫生系统的特点实施激励或强制政策。一些研究表明，实践培训的地点可能会影响 GP 实践的地点。本研究的目的是调查 2018 年至 2021 年间法国各城市培训监督与 GP 密度演变之间是否存在关系。
跟踪几乎所有法国城市的 GP 密度演变。进行了双变量统计分析，以寻找 GP 密度演变与培训监督人数之间的关系。还对其他可能影响 GP 密度的因素（如该地区是否存在财政援助或 GP 的年龄）进行了其他双变量分析。然后使用逐步下降法对双变量分析中有意义的所有变量进行多变量分析。
共纳入 34990 个（99.9%）法国城市进行随访。其中，9427 个（26.9%）有 GP，3866 个（11%）有参与培训监督的 GP。2018 年至 2021 年间，法国城市的 GP 密度平均下降了 2.17%。没有培训监督的地区下降了 4.63%，而至少有一个培训监督的地区增加了 1.36%（p<0.01）。多变量分析也发现了这种显著关系。
培训监督与法国城市 GP 密度的更好演变相关。当考虑其他因素时，这种关联仍然存在。这项为期 3 年的随访结果可能使我们考虑将培训监督作为调节 GP 分布的一个因素。
