RESUMEN
BACKGROUND: Prevention has become a legal obligation for French GPs, since a law was passed in March 2002. AIM: Measurement and analysis of preventive procedures performed by French GPs. DESIGN OF STUDY: Observational survey. Setting GP surgeries in Puy-de-Dôme, France. METHOD: Doctors completed a questionnaire about their socioprofessional characteristics, and a researcher completed another questionnaire about preventive procedures performed on the last 15 patients seen by each GP. Twenty preventive services were evaluated and, for each service, medical records, targets, and objectives were defined according to the national preventive care guidelines. The gap between guidelines and practice was explained by doctor characteristics. Statistical analyses were performed using χ² and logistic regression. RESULTS: Representative samples of 179 doctors and 2453 medical records were randomised. Four preventive services were performed in more than 75% of cases, and the gap was explained by the salaried job the doctors had. Ten preventive services were performed in 25% to 75% of cases and the gap was explained by the medical software used. The six remaining services were performed in less than 25% of cases and no explanatory variable was identified. CONCLUSION: Sixteen preventive procedures were insufficiently performed. The more a preventive service is performed the more the gap will be explained by GPs' socioprofessional characteristics. The gap for a preventive procedure performed in 25% to 75% of cases was mainly explained by management of the medical records. A nationwide policy to improve prevention performance in general practice seems to be essential.
Asunto(s)
Medicina General/estadística & datos numéricos , Rol del Médico , Servicios Preventivos de Salud/estadística & datos numéricos , Métodos Epidemiológicos , Femenino , Francia , Humanos , Masculino , Servicios Preventivos de Salud/normasRESUMEN
OBJECTIVE: Oral anticoagulants (OA) are commonly used, but they can lead to severe bleeding. We studied the indications and monitoring of OA in patients treated by general practitioners. DESIGN: Retrospective cross-sectional study. SETTING: Primary care. PATIENTS: Four hundred thirty-eight randomly selected patients of a population of 2,452 patients treated with OA were studied. INTERVENTIONS: We compared the indications for OA as reported by general practitioners with indications as defined according to recent guidelines. MAIN RESULTS: Twenty-five percent of patients should not have been treated with OA. Inappropriate indications (13% of patients) were atrial fibrillation without risk factor (3.9%), prior uncomplicated myocardial infarction (2.7%), peripheral arterial disease (2.7%), superficial thrombophlebitis (2.3%), and atherothrombotic ischemic stroke (1.6%). For 12% of patients, the duration of OA was too long (venous thromboembolism without permanent risk factor in 10%). Frequency of International Normalized Ratio (INR) measurement was insufficient for 14% of patients and target INR was not achieved in 31%. CONCLUSIONS: Our study demonstrated that clinicians' adherence to recommendations regarding indications for OA and management of this treatment should be improved. Implementation of anticoagulation clinics is probably needed.