French general practitioners' attitudes and prescription patterns toward buprenorphine maintenance treatment: does doctor shopping reflect buprenorphine misuse?

This study investigated attitudes toward buprenorphine maintenance treatment (BMT) among general practitioners (GPs) and their maintained patients' propensity to turn to several prescribers (doctor shopping), among a sample of 345 GPs prescribing BMT in South-Eastern France. Survey data were anonymously matched to administrative data that provided information about GPs' patients. A simultaneous equation model suggests that GPs' attitude influenced doctor shopping, not the reverse. Doctor shopping was lower among GPs who reported inducting BMT with 8 mg of buprenorphine per day or more, and was higher for GPs endorsing a stringent attitude toward patients. Thus doctor shopping should not be understood exclusively as a deviant behaviour. It is partially physician-driven, and further research is needed to assess whether it reflects patients' dissatisfaction toward inappropriate care supply and the difficulty to establish a good therapeutic relationship between an opiate-dependent patient and a general practitioner.

[The appropriateness of the indications and diagnostic efficiency of colonoscopy. Results of a survey conducted in all the hospital centers of the Provence-Alpes-Côte d'Azur area]. / Pertinence des indications et efficience diagnostique des coloscopies. Résultats d'une enquête réalisée dans la totalité des établissements hospitaliers de la région Provence-Alpes-Côte d'Azur.

OBJECTIVE: To evaluate the appropriateness of indications and the diagnostic efficiency of colonoscopy taking into account available guidelines. METHODS: This was a retrospective study conducted by the Union Régionale des Caisses d'Assurance Maladie de Provence-Alpes-Côte d'Azur (URCAM-Paca) aimed at assessing the appropriateness of the indications and diagnostic efficiency of colonoscopy. Anonymous data concerning near totality of the colonoscopies carried out during one week in all the establishments (public and private) of the area, were collected by consulting the medical records. RESULTS: The indications for colonoscopy were first analyzed with regard to the guidelines for good clinical practices (références médicales opposables and consensus conference) according to two scales of reading (literal interpretation and broad interpretation). We noted that the available guidelines do not cover the totality of the colonoscopies performed, that their formulation does not make them all controllable, and that the colonoscopies, which respect them, range from 27.5% (strict reading) to 74.1% (broad reading). When taking into account not only the quality of the preparation, but also the result of the examination after re-classification into benign, pathological or normal examinations, the differences in efficiency appear only when one retains the broad interpretation of the reference guidelines. The efficiency analysis makes it possible to highlight a defect of predictability of the recommendations with regard to the pathologies considered as serious. It also appears that approximately 10% of the colonoscopies are, at the same time, out of the reference and have a normal result, and thus can be considered as absolutely not justified. CONCLUSION: Better compliance of the practitioners to colonoscopy recommendations would initially be generated by improvement in the predictability and the legibility of the current reference guidelines.

[Antecedents of cytological screening among patients treated for invasive cervical neoplasm]. / Antécédents de dépistage cytologique chez les patientes traitées pour cancer infiltrant du col de l'utérus.

OBJECTIVE: The aim of this study is to evaluate if the seriousness of invasive neoplasms of the uterin cervix actually observed is related to the apparition of rapid onset cases. POPULATION: 219 invasive cancers of the cervix treated from 1988 to 1999 in a gynecological oncologic department. METHODS: prognostic factors of cancers have been studied and compared to those of cases treated between 1975 and 1980 in the same department. The existence of cytological screenings has been searched and results have been analysed. RESULTS: Cervical cancers treated during the last 12 years have more serious prognostic factors than those treated during the former period. This evolution is shown by a progression of advanced stages of + 10.2%, an increase of lymph node invasion in proximal stages of + 13,4% and the doubling of number of adenocarcinomas. Though no change of the natural history of cancers has been proved. Only 42% of patients had profited of a cervical screening and cancers diagnosed at "stage I" are statistically more numerous in this group. Improvement should be brought up in the quality of samplings and of the care of abnormal results of cytological screening.