Screening for alcohol use in primary care: assessing French general practitioner practices.

Alcohol use is a leading risk factor for premature death and disability. To tackle this issue, more systematic and accurate screening for at-risk consumption is needed in healthcare systems, especially by general practitioners (GPs). We assessed the frequency of at-risk consumption screening by GPs in France. We also identified characteristics associated with more frequent screening and greater use of validated screening tools by these healthcare providers. A cross-sectional survey was conducted among a representative sample of French GPs. Multinomial logistic regressions were used to identify factors associated with more frequent screening and greater use of validated screening tools. Response rate was of 73%. Of the 2412 participants, 42.8% screened all their patients systematically and repeatedly, while 48.0% never used standardized tools to screen potentially at-risk patients. Among other characteristics, being aware of and using the "early identification and brief intervention" screening strategy, and feeling absolutely comfortable talking with patients about reducing or stopping their alcohol use, were both associated with more frequent screening and use of standardized tools. Our results on at-risk alcohol use screening highlight an improvement over data from previous studies. Nevertheless, better training of French GPs in good alcohol screening practices-specifically, increased screening frequency and greater use of standardized tools-may improve identification of at-risk patients.

Les pratiques des professionnels de santé assurant le suivi gynécologique en Pays de la Loire.

INTRODUCTION: In France, four health care categories ensure primary care gynecological follow-up: general practitioners (GP), medical gynecologists, obstetrician gynecologists and midwives. PURPOSE OF RESEARCH: To describe private health professionals’ ensuring gynecological follow-up in Pays de la Loire (France) in 2018, as well as their respective activities. RESULTS: Our study population was composed of 3764 health professionals, a majority of those being GP. Proportion of aged 60 or older GP in Loire-Atlantique was 25.5%, this proportion was higher in Sarthe (49%). 80% of medical gynecologists were at least 60 years of age and mainly settled in Loire-Atlantique and Maine-et-Loire. Obstetrician gynecologists were older in Mayenne, Sarthe and Vendée. Midwives were relatively younger: 71% were under 50 years of age.On a regional basis, 1 658 155 medical consultations, for any type of gynecological reasons, were identified. Among them, 41.3% were done by GP, 24.3% by gynecologists and 34.4% by midwives. GPs aged 60 or older who represented 30.5% of all GP in Pays de la Loire ensured 26.3% of GP gynecological follow-up, with wide departmental discrepancies. CONCLUSIONS: Medical gynecologist specialty is unequally distributed within the Pays de la Loire area and many professionals are aged 60 or older. Inadequate access to healthcare in this specific field due to the lack of healthcare professional will be soon problematic. Obstetrician gynecologist specialty is better spread, due to care facility locations. A larger volume of activities is taken on by midwives, whereas a wider range of activities is carried out by physicians, according to medical classification.

Expérimentation de la télé-expertise en cardiologie en Pays de la Loire.

INTRODUCTION: General practitioners regularly need specialized advice for therapeutic adaptation, ECG interpretation or to facilitate referral to the local cardiologist. Tele-expertise could amplify these possibilities of coordination between professionals. An experiment in tele-expertise in cardiology was carried out by the URML in Pays de la Loire between 2016 and 2017. This experiment allowed GPs to seek the advice of a liberal cardiologist via a link card. The cardiologist received the card, accompanied by the ECG and responded within 48 hours. OBJECTIVES: The objective was to study the acceptability of the experiment and to study the impact on the coordination of health care professionals and on delays. METHOD: This evaluation required a mixed methodology with a before/after the experiment survey, semi-directive interviews with GP and cardiologists, ad hoc data collection and data from national health insurance claim database. RESULTS: In 15 months of experimentation, 22% of GPs and 52% of liberal cardiologists of the territory participated. 959 reviews were requested by the GPs or 74 cards per month. The cardiologists were solicited 2.3 times a month. The cardiologist rated the ECG abnormal or doubtful for 31.9% of exams. An appointment was scheduled on average within 24 days. Few difficulties in using the service have been reported by users. DISCUSSION: The results show that tele-expertise without any complex computer tools to work, helps to improve the organization of the gradation of the response of the specialized offer, to improve the confidence of GPs in their own ECG analysis. It constitutes a full-scale observatory of the implementation of tele-expertise in cardiology, upstream of its generalization announced for 2020 in France.

[Experience of tele-expertise in cardiology in Pays de la Loire]. / Expérimentation de la télé-expertise en cardiologie en Pays de la Loire.

INTRODUCTION: General practitioners regularly need specialized advice for therapeutic adaptation, ECG interpretation or to facilitate referral to the local cardiologist. Tele-expertise could amplify these possibilities of coordination between professionals. An experiment in tele-expertise in cardiology was carried out by the URML in Pays de la Loire between 2016 and 2017. This experiment allowed GPs to seek the advice of a liberal cardiologist via a link card. The cardiologist received the card, accompanied by the ECG and responded within 48 hours. OBJECTIVES: The objective was to study the acceptability of the experiment and to study the impact on the coordination of health care professionals and on delays. METHOD: This evaluation required a mixed methodology with a before/after the experiment survey, semi-directive interviews with GP and cardiologists, ad hoc data collection and data from national health insurance claim database. RESULTS: In 15 months of experimentation, 22% of GPs and 52% of liberal cardiologists of the territory participated. 959 reviews were requested by the GPs or 74 cards per month. The cardiologists were solicited 2.3 times a month. The cardiologist rated the ECG abnormal or doubtful for 31.9% of exams. An appointment was scheduled on average within 24 days. Few difficulties in using the service have been reported by users. DISCUSSION: The results show that tele-expertise without any complex computer tools to work, helps to improve the organization of the gradation of the response of the specialized offer, to improve the confidence of GPs in their own ECG analysis. It constitutes a full-scale observatory of the implementation of tele-expertise in cardiology, upstream of its generalization announced for 2020 in France.