Regards croisés sur les pratiques préventives des médecins généralistes :Retour sur les études Prev Quanti et Prev Quali

Rapport de recherche pour l’Institut National de Prévention et d’Education pour la Santé, décembre 2014, vol. 1 et 2.;

General practitioners’ relationship with preventive knowledge: a qualitative study

General practitioners (GPs) do not provide enough preventive care. Nonetheless, without a detailed understanding of the logical processes that underlie their practices, it remains difficult to develop effective means of improvement. Their relationship to knowledge is one of three elements that strongly structure GPs’ preventive work (together with the doctor–patient relationship and the organisation of their professional space).The objective of this article was to explore the question of GPs’ relationship to knowledge about prevention. In 2010–2011, semi-directive interviews with a diverse sample of 100 GPs practising in the Paris metropolitan area were conducted. These interviews were cod…

Des inégalités sociales de santé aux gradients sociaux dans les pratiques préventives des médecins généralistes

National audience;

Level of agreement between physician and patient assessment of non-medical health factors.

Background GPs need to consider assorted relevant non-medical factors, such as family or work situations or health insurance coverage, to determine appropriate patient care. If GPs' knowledge of these factors varies according to patients' social position, less advantaged patients might receive poorer care, resulting in the perpetuation of social inequalities in health. Objective To assess social disparities in GPs' knowledge of non-medical factors relevant to patient care. Methods Observational survey of GPs who supervise internships in the Paris metropolitan area. Each of the 52 enrolled GPs randomly selected 70 patients from their patient list. Their knowledge of five relevant factors (co…

Are primary-care physician practices related to health behaviors likely to reduce social inequalities in health?

Abstract Our objective was to examine patients' health behaviors and the related practices of their primary-care physicians to determine whether physicians' actions might help to reduce the social inequalities in health behaviors among their patients. Fifty-two general practitioners, who were also medical school instructors in the Parisian area, volunteered to participate. A sample of 70 patients (stratified by sex) aged 40–70 years was randomly chosen from each physician's patient panel and asked to complete a questionnaire about their social position and health behaviors: tobacco and alcohol use, diet, physical activity, and participation in breast and cervical cancer screening. Each phys…

Avec tact et mesure ? Les médecins généralistes français aux prises avec les évaluations chiffrées de leur pratique

L’article s’interesse aux effets de l’evaluation chiffree de la qualite des pratiques en medecine generale. La mise en perspective des reformes concernant la medecine generale liberale en France montre que le deploiement progressif de dispositifs d’encadrement de la pratique connait aujourd’hui un tournant metrologique decisif. Nous en envisageons le retentissement sur les generalistes a partir de deux etudes originales consacrees aux soins preventifs. Les critiques et formes de resistance professionnelles sont examinees, avant d’approfondir l’experience et les arguments des praticiens qui consentent a la mesure du travail medical, voire s’en saisissent, pour apprecier les inflexions en cou…

Factors associated with GPs' knowledge of their patients' socio-economic circumstances: a multilevel analysis.

A paraître; International audience; Background. To determine appropriate management for individual patients, GPs are supposed to use their knowledge of the patient's socio-economic circumstances.Objective. To analyse factors associated with GPs' knowledge of these circumstances.Methods. Observational survey of GPs who were internship supervisors in the Paris metropolitan area. Each of 52 volunteer GPs completed a self-administered questionnaire about their own characteristics and randomly selected 70 patients from their patient list. Their knowledge was analysed as the agreement between the patients' and GPs' responses to questions about the patients' socio-economic characteristics in quest…

Les pratiques préventives des généralistes sont-elles de nature à réduire les inégalités sociales de santé ?

Time and feasibility of prevention in primary care

BACKGROUND Prevention is an essential task in primary care. According to primary care physicians (PCPs),lack of time is one of the principal obstacles to its performance. OBJECTIVE To assess the feasibility of prevention in terms of time by estimating the time necessary to perform all of the preventive care recommended, separately from the PCPs and patient's perspectives, and to compare them to the amount of time available. METHODS A review of the literature identified the prevention procedures recommended in France, the duration of each procedure and its recommended frequency, as well as PCPs' consultation time. A hypothetical patient panel size of 1000 patients, representative of the Fren…

Pratiques préventives en médecine générale : une analyse qualitative par entretiens

Rapport de recherche pour l’Union Régionale des Professions de Santé d’Ile de France;

Le social à l’épreuve, l’épreuve du social. Ou l'art d'accommoder la position sociale des patients dans le travail préventif en médecine générale

Resume Objectif Cet article interroge la maniere dont les medecins generalistes liberaux prennent en compte la position sociale de leurs patients dans leur travail preventif. Methode Apres une revue des principales constructions normatives censees equiper les generalistes pour l’apprehension des dimensions sociales, l’article utilise deux enquetes sur la dispensation des soins preventifs, l’une epidemiologique (PrevQuanti) et l’autre sociologique (PrevQuali). Resultats La deontologie, la formation et les recommandations mettent difficilement en forme les dimensions sociales de la sante avec lesquelles doivent composer les generalistes. L’enquete PrevQuanti a pourtant mis en evidence que la …

En quête de pertinence et d’égalité ? Quand les prescriptions des dépistages des cancers gynécologiques s’emmêlent

The Search for Relevance and Equality. When Prescriptions for Gynaecologic Cancer Screening Create ConfusionThis article cross-references epidemiology and sociology to examine the social inequalities involved in screening for gynaecologic, cervical and breast cancers. It describes the “ordinary” prescription approaches used for these screenings by referring them to a system of prescribers, the aim being to see how they shed light on the fabric of social inequalities in gynaecologic screening. The analysis reviews the main professional players, including gynaecologists and general practitioners, and investigates how their approaches coexist rather than existing in synergy, to identify issues…

(Se) Former aux méthodes qualitatives : modalités et enjeux d’une rencontre sociologue-médecins généralistes

International audience