Selection of proxy indicators estimating the appropriateness of antibiotic prescriptions in general practice: a national consensus procedure in France.

Background: GPs are responsible for more than 70% of outpatient antibiotic prescriptions in France. Metrics are important antibiotic stewardship tools that can be used to set targets for improvement and to give feedback to professionals and stakeholders. Objectives: The primary objective of the present study was to select a set of proxy indicators (PIs) based on 10 previously developed PIs, to estimate the appropriateness of antibiotic prescriptions by GPs. The secondary objective was to evaluate the clinimetric properties of the selected PIs. Methods: A RAND-modified Delphi consensus procedure was conducted with a multidisciplinary panel of stakeholders. This procedure consisted of two successive online surveys with a consensus meeting in between. Clinimetric properties (measurability, applicability and potential room for improvement) were evaluated for the PIs selected through the consensus procedure, using 2022 Regional Health Insurance data. Results: Seventeen experts participated in the first-round survey and 14 in the second-round. A final set of 12 PIs was selected. Among the 10 initial PIs, 3 were selected without modification and 7 were modified and selected. Moreover, two newly suggested PIs were selected. Ten of the 12 PIs presented good clinimetric properties. Conclusions: The 12 selected PIs cover the main situations responsible for inappropriate and unnecessary use of antibiotics in general practice. These PIs, easily calculable using routinely collected health insurance reimbursement data, might be used to give feedback to prescribers and stakeholders and help improve antibiotic prescriptions in primary care.

Associations between depressive symptoms with suicide behaviors and negative relationships with mother and father in early adolescents: a population-based study.

BACKGROUND: Adolescent-parent negative relationships may favour depressive symptoms only (DSonly) and more strongly those plus suicide ideation (DSSI) or attempt (DSSA) in early adolescents (10-16 years). We assessed their associations which remain poorly addressed. METHODS: This study included 1256 middle-school adolescents from north-eastern France (mean age 13.5±1.3). They completed a questionnaire gathering socioeconomic features, academic performance, substance (alcohol, tobacco, cannabis and other substances) use, relationships with father and mother, depressive symptoms, last-12-month suicide ideation, and lifetime suicide attempt. For depressive symptoms and suicide attempt, the time of the first occurrence during adolescent's life course was also gathered. Data were analyzed using multinomial logistic regression models and Kaplan-Meier survival estimates. RESULTS: Many adolescents suffered from DSonly (8.0%), DSSI (2.5%) and DSSA (3.9%) and from negative relationships with father only (NRfather, 11.2%), mother only (NRmother, 6.1%), and both parents (NRboth parents, 10.9%). DSSA was more strongly associated (P<0.001) with NRmother (sex-age-adjusted odds ratio saOR=14.34) and NRboth parents (saOR=12.15) than NRfather (saOR=4.57). Similar results were found for DSSI (saOR 12.90, 12.23 and 2.16, respectively) and DSonly (saOR 4.18, 4.84 and 3.18, respectively). These results remained strong when controlling for socioeconomic features, academic performance and substance use (contribution reaching 62%). The risk early began and then steadily increased over time. CONCLUSIONS: Adolescent-parent negative relationships favor DSonly and more strongly DSSI and DSSA. Mother had a much higher role than father. The role and support of both parents should be considered for prevention and care to reduce adolescents' mental health difficulties.

Antibiotic stewardship in French nursing homes: a 2019 regional survey.

BACKGROUND: Antibiotic resistance is a growing issue in nursing homes (NHs). Antibiotic stewardship (ABS) programmes can reduce antibiotic use in NHs, but few studies have assessed to what extent they are implemented in NHs. OBJECTIVES: To describe ABS current practices and describe the opinion of NH stakeholders regarding ABS and opportunities for improvement in one French region. METHODS: We invited by e-mail the medical and nurse coordinators of all NHs of the Grand Est region, France, to participate in our survey in 2019. The online questionnaire included 35 questions covering four topics: NH characteristics, current ABS practices, attitudes towards ABS and opinions on strategies to promote ABS. A score evaluating implementation of core ABS elements was calculated using the current ABS practice responses. RESULTS: Out of 417 NHs, 75 (18%) participated in our survey. The three most implemented ABS activities were antibiotic consumption monitoring (65%), antibiotic plan documentation (56%) and antibiotic prescription guide distribution (54%). Audit and feedback, training sessions or identification of a local ABS leader ranged from 13% to 29%. Participants positively perceived ABS and most suggestions to improve ABS programmes in NH, with maximal interest in training, audit and feedback interventions. The median score for implementation of core ABS elements was 3.3 (IQR = 2.3-5.4; theoretical range 0-11), and the score distribution was not associated with any NH characteristic. CONCLUSIONS: While there is still room for improvement, NHs had a positive attitude towards ABS strategies. Some regional and national initiatives to promote ABS in NHs exist and should be actively promoted.

Postponing vaccination in children with an infection: a qualitative study among general practitioners and pediatricians.

BACKGROUND: Vaccination postponement is an important contributing factor to low vaccination coverage. The causes of vaccine postponement are numerous, but the presence of viral infection, whether febrile or not, is the most frequent cause. OBJECTIVE: The objective was to explore the factors motivating the practice of vaccination postponement in a child with an infection by general practitioners (GPs) and paediatricians. METHODS: An exploratory qualitative study using semi-directive individual interviews was carried out among GPs and paediatricians in a French region between November 2015 and January 2018. After the interviews were fully transcribed, an analysis of the data was performed using an inductive method derived from the grounded theory. RESULTS: Fourteen GPs and four paediatricians participated in the study. Vaccination postponement during infection in children is rooted in doctors' practices; it is considered a low-risk habit that is shared with parents, and vaccine hesitancy reinforces this practice. In children presenting with an infection, the presence of uncertainty about vaccine safety and effectiveness seems to justify postponing vaccination. The organization of a consultation dedicated to vaccination catch-up was cited as the best tool to limit the effects of vaccination delay on vaccination coverage. DISCUSSION: In children presenting with an infection, vaccination postponement is widely used by GPs and paediatricians. Simplification of the vaccination catch-up process and clear and consistent recommendations on the indications and modalities for vaccination postponement would be useful.

[Not Available]. / Organiser le parcours de soins de la femme hypertendue enceinte.

The General Practitioner has a role in monitoring women with hypertension during pregnancy, for all women presenting with pre-existing chronic hypertension, a personal history of preeclampsia or with pregnancy-induced hypertension. It may be designated coordinator of monitoring during the first two quarters if he has the skills. Monitoring will then be performed in close coordination with other practitioners with a Personal Pregnancy Care-Plan notebook. Other complications and, in particular, the occurrence of proteinuria, require immediate recourse to the gynaecologist-obstetrician who will become the monitoring coordinator. The coordination of the monitoring will be the responsibility of the gynaecologist-obstetrician from the 3rd trimester.