Université Claude Bernard Lyon 1, Collège universitaire de médecine générale, F-69008 Lyon, France
Paris-Saclay, UVSQ, Inserm, CESP, Villejuif, France; and Institut national d'études démographiques (INED), Aubervilliers, France
Rural Remote Health. 2023 May;23(2):7359. doi: 10.22605/RRH7359. Epub 2023 May 25.
Technical skills have many areas of application in general practice and are a dimension of medical competence. Several studies have attempted to describe the technical procedures performed in general practice but most had limitations in the data collection process, the scope of the procedures addressed, or the healthcare actors involved. No French comparable data have been published. The aim of the present study was therefore to describe the frequency and type of technical procedures in French general practice, and to assess their determinants, in particular rurality.
The present study was ancillary to the ECOGEN (Eléments de la COnsultation en médecine GENérale) study, which was an observational cross-sectional, multicentre, nationwide study conducted in 128 French general practices. Data were collected on 20 613 patient-GP encounters, including the characteristics of GPs and encounters, as well as the health problems managed during the encounter and their associated processes of care; the latter two variables were coded according to the International Classification of Primary Care classification. The GPs' practice location was first classified as rural area, urban cluster, or urban area; the former two categories were combined for analysis. The various technical procedures were classified according to the framework of the International Classification of Process in Primary Care. The frequency of each technical procedure was compared according to GP practice location. The dependent variable analysed was the performance of at least one technical procedure per each health problem managed. Bivariate analysis was performed for all independent variables followed by multivariate analysis for key variables, using a hierarchical model including three levels: the physician, the encounter, the health problem managed.
The data included 2202 technical procedures performed. At least one technical procedure was performed in 9.9% of encounters and for 4.6% of health problems managed. The two most frequent groups of technical procedures performed were injections (44.2% of all procedures) and clinical laboratory procedures (17.0%). The following procedures were more often performed by GPs practicing in a rural area or an urban cluster than those practicing in an urban area: injection of joints, bursae, tendons and tendon sheaths (4.1% v 1.2% of all procedures), manipulation and osteopathy (10.3% v 0.4%), excision/biopsy of superficial lesions (1.7% v 0.5%), and cryotherapy (1.7% v 0.3%). Conversely, the following procedures were more often performed by GPs practicing in urban areas: vaccine injection (46.6% v 32.1%), point-of-care testing for group A streptococci (11.8% v 7.6%), and ECG (7.6% v 4.3%). GPs practicing in a rural area or an urban cluster performed more often technical procedures than those practising in an urban area (odds ratio=1.31, 95% confidence interval 1.04-1.65), according to the multivariate model.
Technical procedures were more frequently performed and more complex when they were performed in French rural and urban cluster areas. More studies are required to assess patients' needs regarding technical procedures.
技术技能在全科医学中有许多应用领域，是医疗能力的一个维度。有几项研究试图描述全科医学中实施的技术程序，但大多数研究在数据收集过程、所涉及的程序范围或医疗保健参与者方面都存在局限性。没有可比的法国数据公布。因此，本研究的目的是描述法国全科医学中技术程序的频率和类型，并评估其决定因素，特别是农村地区。
本研究是 ECOGEN（Eléments de la COnsultation en médecine GENérale）研究的辅助研究，该研究是一项在法国 128 家全科诊所进行的观察性横断面、多中心、全国性研究。共收集了 20613 例患者-全科医生就诊的数据，包括全科医生和就诊的特征，以及就诊期间管理的健康问题及其相关的护理流程；后两个变量根据初级保健国际分类进行编码。全科医生的执业地点首先被归类为农村地区、城镇集群或城市地区；前两个类别被合并进行分析。各种技术程序根据初级保健国际分类过程框架进行分类。根据管理的每个健康问题的技术程序的频率进行比较。分析的因变量是每个管理的健康问题至少进行一次技术程序。对所有自变量进行了单变量分析，然后对关键变量进行了多变量分析，使用包括医生、就诊、管理的健康问题三个层次的层次模型。
数据包括 2202 项技术程序。在 9.9%的就诊中至少进行了一项技术程序，在 4.6%的健康问题管理中进行了技术程序。实施频率最高的两组技术程序是注射（所有程序的 44.2%）和临床实验室程序（17.0%）。在农村地区或城镇集群执业的全科医生比在城市地区执业的全科医生更常进行以下程序：关节、滑囊、肌腱和腱鞘注射（4.1%v 所有程序的 1.2%）、推拿和整骨疗法（10.3%v 0.4%）、浅表病变切除/活检（1.7%v 0.5%）和冷冻疗法（1.7%v 0.3%）。相反，在城市地区执业的全科医生更常进行以下程序：疫苗注射（46.6%v 32.1%）、A 组链球菌即时检测（11.8%v 7.6%）和心电图（7.6%v 4.3%）。根据多变量模型，在农村地区或城镇集群执业的全科医生比在城市地区执业的全科医生更常进行技术程序（优势比=1.31，95%置信区间 1.04-1.65）。
在法国农村和城镇集群地区，技术程序的实施频率更高，也更复杂。需要进一步研究以评估患者对技术程序的需求。
