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Adherence of French GPs to chronic neuropathic pain clinical guidelines: results of a cross-sectional, randomized, "e" case-vignette survey.

ABSTRACT: BACKGROUND AND AIMS: The French Pain Society published guidelines for neuropathic pain management in 2010. Our aim was to evaluate the compliance of GPs with these guidelines three years later. METHODS: We used "e" case vignette methodology for this non interventional study. A national panel of randomly selected GPs was included. We used eight "e" case-vignettes relating to chronic pain, differing in terms of the type of pain (neuropathic/non neuropathic), etiology (cancer, postoperative pain, low back pain with or without radicular pain, diabetes) and symptoms. GPs received two randomly selected consecutive "e" case vignettes (with/without neuropathic pain). We analyzed their ability to recognize neuropathic pain and to prescribe appropriate first-line treatment. RESULTS: From the 1265 GPs in the database, we recruited 443 (35.0%), 334 of whom logged onto the web site (26.4%) and 319 (25.2%) of whom completed the survey. Among these GPs, 170 (53.3%) were aware of the guidelines, 136 (42.6%) were able to follow them, and 110 (34.5%) used the DN4 diagnostic tool. Sensitivity for neuropathic pain recognition was 87.8% (CI: 84.2%; 91.4%). However, postoperative neuropathic pain was less well diagnosed (77.9%; CI: 69.6%; 86.2%) than diabetic pain (95.2%; CI: 90.0%; 100.0%), cancer pain (90.6%; CI: 83.5%; 97.8%) and typical radicular pain (90.7%; CI: 84.9%; 96.5%). When neuropathic pain was correctly recognized, the likelihood of appropriate first-line treatment prescription was 90.6% (CI: 87.4%; 93.8%). The treatments proposed were pregabaline (71.8%), gabapentine (43.9%), amiptriptylline (23.2%) and duloxetine (18.2%). However, ibuprofen (11%), acetaminophen-codeine (29.5%) and clonazepam (10%) were still prescribed. CONCLUSIONS: The compliance of GPs with clinical practice guidelines appeared to be satisfactory, but differed between etiologies.

SUBMITTER: Martinez V

PROVIDER: S-EPMC3991574 | biostudies-other | 2014

REPOSITORIES: biostudies-other

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Adherence of French GPs to chronic neuropathic pain clinical guidelines: results of a cross-sectional, randomized, "e" case-vignette survey.

Martinez Valéria V Attal Nadine N Vanzo Bertrand B Vicaut Eric E Gautier Jean Michel JM Bouhassira Didier D Lantéri-Minet Michel M

PloS one 20140418 4

<h4>Background and aims</h4>The French Pain Society published guidelines for neuropathic pain management in 2010. Our aim was to evaluate the compliance of GPs with these guidelines three years later.<h4>Methods</h4>We used "e" case vignette methodology for this non interventional study. A national panel of randomly selected GPs was included. We used eight "e" case-vignettes relating to chronic pain, differing in terms of the type of pain (neuropathic/non neuropathic), etiology (cancer, postoper ...[more]

PMID: 24747826

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Project description:BackgroundIn developed countries, primary care physicians manage most patients with depression. Relatively few studies allow a comprehensive assessment of the decisions these doctors make in these cases and the factors associated with these decisions. We studied how general practitioners (GPs) manage the acute phase of a new episode of non-comorbid major depression (MD) and the factors associated with their decisions.Methodology/principal findingsIn this cross-sectional telephone survey, professional investigators interviewed an existing panel of randomly selected GPs (1249/1431, response rate: 87.3%). We used case-vignettes about new MD episodes in 8 versions differing by patient gender and socioeconomic status (blue/white collar) and disease intensity (mild/severe). GPs were randomized to receive one of these 8 versions. Overall, 82.6% chose pharmacotherapy; among them GPs chose either an antidepressant (79.8%) or an anxiolytic/hypnotic alone (18.5%). They rarely recommended referral for psychotherapy alone, regardless of severity, but 38.2% chose it in combination with pharmacotherapy. Antidepressant prescription was associated with severity of depression (OR?=?1.74; 95%CI?=?1.33-2.27), patient gender (female, OR?=?0.75; 95%CI?=?0.58-0.98), GP personal characteristics (e.g. history of antidepressant treatment: OR?=?2.31; 95%CI?=?1.41-3.81) and GP belief that antidepressants are overprescribed in France (OR?=?0.63; 95%CI?=?0.48-0.82). The combination of antidepressants and psychotherapy was associated with severity of depression (OR?=?1.82; 95%CI?=?1.31-2.52), patient's white-collar status (OR?=?1.58; 95%CI?=?1.14-2.18), and GPs' dissatisfaction with cooperation with mental health specialists (OR?=?0.63; 95%CI?=?0.45-0.89). These choices were not associated with either GPs' professional characteristics or psychiatrist density in the GP's practice areas.Conclusions/significanceGPs' choices for treating severe MD complied with clinical guidelines better than those for mild MD; GPs rarely recommended psychotherapy alone but rather as a complement to pharmacotherapy. Their decisions were mainly influenced by personal life experience and attitudes regarding treatment more than by professional characteristics. These results call into question the methods and content of continuing medical education in France about MD management.

Project description:ObjectivesThe mistreatment of medical students remains pervasive in medical education. Understanding the extent to which clinicians and students recognise mistreatment can assist in creating targeted interventions that reduce mistreatment. The objective of this study was to use clinical vignettes to assess perceptions of medical student mistreatment among medical students and clinical faculty at an Australian university.Design, setting and participantsThis cross-sectional study used a survey of medical students and clinical faculty in a Doctor of Medicine (MD) programme at Macquarie University in Sydney, Australia. Data were collected via an online survey between 13 July and 27 July 2020.Outcome measuresFourteen clinical vignettes were developed based on commonly reported themes of mistreatment. An additional control vignette was also included, and these 15 vignettes were distributed via email to all 169 MD students and 42 teaching faculty at this teaching site. Participants were asked to rate whether the vignettes portrayed mistreatment on a 5-point Likert scale (strongly disagree to strongly agree).ResultsRespondents included 83 MD students and 34 clinical faculty. On average, students perceived mistreatment in 9 of 14 vignettes and faculty in 8 of 14 vignettes. Faculty and student perceptions aligned in themes of sexual abuse, physical abuse and in the control vignette depicting a constructive teaching style. Perceptions differed significantly between faculty and students (p<0.05) for five vignettes across the themes of gender discrimination, requests of students to perform non-educational tasks, humiliation, specialty choice discrimination and requests to perform a task beyond the student's capacity.ConclusionAgreement on what constitutes appropriate behaviour is crucial to ensuring that a culture of mistreatment can be replaced with one of kindness, equity and respect. This study demonstrated the successful use of vignettes to compare perceptions of mistreatment, with faculty and student perceptions differing across a variety of themes.

Dataset Information

Adherence of French GPs to chronic neuropathic pain clinical guidelines: results of a cross-sectional, randomized, "e" case-vignette survey.

Publications

Adherence of French GPs to chronic neuropathic pain clinical guidelines: results of a cross-sectional, randomized, "e" case-vignette survey.

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