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How do general practitioners put preventive care recommendations into practice? A cross-sectional study in Switzerland and France.

ABSTRACT: OBJECTIVES:We previously identified that general practitioners (GPs) in French-speaking regions of Europe had a variable uptake of common preventive recommendations. In this study, we describe GPs' reports of how they put different preventive recommendations into practice. DESIGN, SETTING AND PARTICIPANTS:Cross-sectional study conducted in 2015 in Switzerland and France. 3400 randomly selected GPs were asked to complete a postal (n=1100) or online (n=2300) questionnaire. GPs who exclusively practiced complementary and alternative medicine were not eligible for the study. 764 GPs (response rate: postal 47%, online 11%) returned the questionnaire (428 in Switzerland and 336 in France). MAIN OUTCOME MEASURES:We investigated how the GPs performed five preventive practices (screening for dyslipidaemia, colorectal and prostate cancer, identification of hazardous alcohol consumption and brief intervention), examining which age group they selected, the screening frequency, the test they used, whether they favoured shared decision for prostate cancer screening and their definition of hazardous alcohol use. RESULTS:A large variability was observed in the way in which GPs provide these practices. 41% reported screening yearly for cholesterol, starting and stopping at variable ages. 82% did not use any test to identify hazardous drinking. The most common responses for defining hazardous drinking were, for men, ?21?drinks/week (24%) and ?4?drinks/occasion for binge drinking (20%), and for women, ?14?drinks/week (28%) and ?3?drinks/occasion (21%). Screening for colorectal cancer, mainly with colonoscopy in Switzerland (86%) and stool-based tests in France (93%), was provided every 10 years in Switzerland (65%) and 2?years in France (91%) to patients between 50 years (87%) and 75 years (67%). Prostate cancer screening, usually with shared decision (82%), was provided yearly (62%) to patients between 50 years (74%) and 75-80 years (32%-34%). CONCLUSIONS:The large diversity in the way these practices are provided needs to be addressed, as it could be related to some misunderstandingof the current guidelines, to barriers for guideline uptake or, more likely, to the absence of agreement between the various recommendations.

SUBMITTER: Sebo P

PROVIDER: S-EPMC5640000 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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How do general practitioners put preventive care recommendations into practice? A cross-sectional study in Switzerland and France.

Sebo Paul P Cerutti Bernard B Fournier Jean-Pascal JP Rat Cédric C Rougerie Fabien F Senn Nicolas N Haller Dagmar M DM Maisonneuve Hubert H

BMJ open 20171006 10

<h4>Objectives</h4>We previously identified that general practitioners (GPs) in French-speaking regions of Europe had a variable uptake of common preventive recommendations. In this study, we describe GPs' reports of how they put different preventive recommendations into practice.<h4>Design, setting and participants</h4>Cross-sectional study conducted in 2015 in Switzerland and France. 3400 randomly selected GPs were asked to complete a postal (n=1100) or online (n=2300) questionnaire. GPs who e ...[more]

PMID: 28988186

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Project description:BackgroundThere is limited United Kingdom (UK) literature on general practice-based pharmacists' (PBPs') role evolution and few studies have explored general practitioners' (GPs') experiences on pharmacist integration into general practice. Therefore, this study aimed to investigate GPs' experiences with, views of, and attitudes towards PBPs in Northern Ireland (NI).MethodsA paper-based self-administered questionnaire comprising four sections was mailed in 2019 to 329 general practices across NI and was completed by one GP in every practice who had most contact with the PBP. Descriptive analyses were used and responses to open-ended questions were analysed thematically.ResultsThe response rate was 61.7% (203/329). There was at least one PBP per general practice. All GPs had face-to-face meetings with PBPs, with three-quarters (78.7%, n = 159) meeting with the PBP more than once a week. Approximately two-thirds of GPs (62.4%, n = 126) reported that PBPs were qualified as independent prescribers, and 76.2% of these (n = 96/126) indicated that prescribers were currently prescribing for patients. The majority of GPs reported that PBPs always/very often had the required clinical skills (83.6%, n = 162) and knowledge (87.0%, n = 167) to provide safe and effective care for patients. However, 31.1% (n = 61) stated that PBPs only sometimes had the confidence to make clinical decisions. The majority of GPs (> 85%) displayed largely positive attitudes towards collaboration with PBPs. Most GPs agreed/strongly agreed that PBPs will have a positive impact on patient outcomes (95.0%, n = 192) and can provide a better link between general practices and community pharmacists (96.1%, n = 194). However, 24.8% of GPs (n = 50) were unclear if the PBP role moved community pharmacists to the periphery of the primary care team. An evaluation of the free-text comments indicated that GPs were in favour of more PBP sessions and full-time posts.ConclusionMost GPs had positive views of, and attitudes towards, PBPs. The findings may have implications for future developments in order to extend integration of PBPs within general practice, including the enhancement of training in clinical skills and decision-making. Exploring PBPs', community pharmacists' and patients' views of this role in general practice is required to corroborate study findings.

Project description:Objective: To test whether demographic and health-related characteristics are associated with non-attendance of preventive health checks offered to individuals with low levels of education using proactive recruitment by the general practitioners. Design: A cross-sectional study. Setting: 32 general practice clinics in Copenhagen, Denmark. Subjects: A total of 549 individuals aged 45-64, with low levels of education, enrolled in the intervention group of a randomised controlled trial on preventive health checks offered by general practitioner. Main outcome measures: Non-attendance of the preventive health checks. Methods: (i) Descriptive characteristics of attendees and non-attendees and (ii) crude and adjusted multi-level logistic regression to examine associations of individual characteristics with non-attendance of preventive health checks. Results: Overall, 33% did not attend the prescheduled preventive health checks at their general practitioners. Non-attendees were more likely to live without a partner, be of non-Western origin, be daily smokers, have poor self-rated health, have higher pulmonary symptoms score, have increased level of stress, have low levels of self-efficacy, have metabolic risk factors or non-communicable diseases and have had no contact with their general practitioner within the past year. Conclusion: The findings suggest that, it is feasible to use general practitioners for recruiting individuals for preventive health checks. However, even in a trial targeting individuals with low levels of education, there are differences between attendees and non-attendees, with a more adverse health behaviour profile and worse health status observed among the non-attendees. KEY POINTS Current awareness • Non-attendance of preventive health checks offered to the general population is associated with low socioeconomic position and adverse health behaviours. Main statements • It is feasible to use general practitioners proactively in recruitment to preventive health checks offered to individuals with low socioeconomic positions. • In a trial targeting individuals with low levels of education, there were differences between attendees and non-attendees. • Non-attendance was associated with daily smoking, poor self-rated health, high stress and no contact with the general practitioner within the last year.

Project description:Background Statins are a first line, evidence-based yet underprescribed treatment for cardiovascular primary prevention. In primary care settings, multimorbidity is a complex situation which makes it difficult to apply prevention guidelines. Aim To assess the associations between multimorbidity and prescription of statins in accordance with the 2016 ESC recommendations (“appropriate prescription”), and to identify the factors and conditions associated with these prescriptions. Design and setting Cross-sectional prospective study in the French region of Rhône-Alpes among 40 general practitioners and their patients. Methods We examined the association between appropriate statin prescription and several patient characteristics, including multimorbidity, using multivariate logistic regression models. Results Between August 2017 and February 2019, 327 patients were included in the study. Seventy-four (22.6%) were on statin medication and 199 (60.9%) exhibited multimorbidity, defined as ≥2 diseases. Only 22.5% of eligible patients were prescribed statins for primary prevention. Diabetes was most strongly associated with appropriate statin prescription (aOR 8.10, CI 95: 3.81–17.80). Multimorbidity was not associated with appropriate statin prescription (aOR 1.31, CI 95: 0.54–3.26), except in the presence of diabetes which defined diabetic multimorbidity (aOR 10.46, CI 95: 4.87–23.35). Conversely, non-diabetic multimorbidity was associated with lower odds of being appropriately prescribed a statin (aOR 0.26, CI 95: 0.12–0.56). Conclusion Multimorbidity, in itself, does not seem to be a determinant factor for appropriate statin prescription. The latter appears to be determined by a patient’s type of multimorbidity, especially the presence or not of diabetes. Differentiating between diabetic and non-diabetic multimorbidity may be a pragmatic way for GPs to improve primary prevention in a patient-centered and shared decision-making approach.

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How do general practitioners put preventive care recommendations into practice? A cross-sectional study in Switzerland and France.

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How do general practitioners put preventive care recommendations into practice? A cross-sectional study in Switzerland and France.

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