Neurology Department and Parkinson's Disease Expert Center, University Hospital of Amiens, Amiens, France.
Department of General Medicine, University of Picardy Jules-Verne (UPJV), Amiens, France.
Rev Neurol (Paris). 2024 Sep;180(7):650-654. doi: 10.1016/j.neurol.2024.02.388. Epub 2024 Mar 30.
BACKGROUND: Parkinson's disease (PD), the second most frequent neurodegenerative disease, constitutes a major public health challenge. A guide published by the French National Authority for Health in 2012 and revised in 2016 put forward recommendations for general practitioners (GP) planning care pathways for parkinsonian patients. It is well known that PD can be difficult to diagnose, and that when patients consult their GP, symptoms are often still limited and embedded in clinical uncertainty. This means the pathway to confirmed diagnosis of PD can be lengthy and uncertain. Consequently, it is important to identify the difficulties GPs encounter when caring for PD patients in order to help them better close the gaps in care strategies. METHODS: We conducted a descriptive cross-sectional survey in northern France to evaluate GP practices and knowledge about PD and their accordance with care pathway recommendations. The survey was conducted using a 30-item questionnaire sent to a sample of GPs. RESULTS: There were 164 GPs who responded to the study questionnaire. The responding GPs generally followed current care pathway recommendations. In presence of a parkinsonian syndrome, 93.3% of the GPs reported systematically looking for an iatrogenic cause; 57.4% did not announce the diagnosis without the advice of a neurologist; 97.6% referred patients to a neurologist when they suspected PD; and 80.5% asked the neurologist to modify treatments. Our findings also revealed some difficult aspects of GP practices: only 2.5% had had additional training in neurology; only 53.6% felt comfortable with the diagnosis of PD; 63.6% prescribed additional exams for the diagnosis; most of the GPs were unaware of second-line treatments and their indications, and finally existence of PD expert centers was unknown for 85.2%. CONCLUSIONS: These findings could be useful to guide implementation of new measures supporting more holistic care for PD patients; PD expert centers in France could provide complementary information and training for GPs.
背景：帕金森病（PD）是第二常见的神经退行性疾病，是一个主要的公共卫生挑战。法国国家卫生管理局于 2012 年发布并于 2016 年修订的指南为全科医生（GP）规划帕金森病患者的护理路径提出了建议。众所周知，PD 诊断困难，当患者咨询他们的 GP 时，症状通常仍然有限，且存在临床不确定性。这意味着 PD 的确诊路径可能漫长且不确定。因此，确定 GP 在照顾 PD 患者时遇到的困难对于帮助他们更好地缩小护理策略差距很重要。
方法：我们在法国北部进行了一项描述性横断面调查，以评估 GP 对 PD 的实践和知识及其与护理路径建议的一致性。该调查使用了一份包含 30 个问题的问卷，分发给了一组 GP。
结果：共有 164 名 GP 对研究问卷做出了回应。这些回复的 GP 通常遵循当前的护理路径建议。当存在帕金森综合征时，93.3%的 GP 报告系统地寻找医源性病因；57.4%的 GP 在没有神经科医生建议的情况下不宣布诊断；97.6%的 GP 在怀疑 PD 时将患者转介给神经科医生；80.5%的 GP 要求神经科医生修改治疗方案。我们的研究结果还揭示了 GP 实践中的一些困难方面：只有 2.5%的 GP 接受过额外的神经病学培训；只有 53.6%的 GP 对 PD 的诊断感到舒适；63.6%的 GP 为诊断开了额外的检查；大多数 GP 不知道二线治疗及其适应证，最后，85.2%的 GP 不知道 PD 专家中心的存在。
结论：这些发现有助于指导实施支持 PD 患者更全面护理的新措施；法国的 PD 专家中心可以为 GP 提供补充信息和培训。
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