Preventive service delivery: A new insight into French general practice

The role of general practitioners in Reunion in detecting alcohol use in pregnant women and identifying fetal alcohol spectrum disorder: a qualitative study

BACKGROUND

Fetal Alcohol Spectrum Disorder (FASD) is the leading cause of non-genetic intellectual disability and social maladjustment in children. International guidelines recommend abstinence from alcohol during pregnancy. Réunion is the most affected of all French regions with an estimated Fetal Alcohol Spectrum (FAS) prevalence of 1.2‰ births. General practitioners (GPs) are at the forefront of identifying patients with FASD.

OBJECTIVE

To understand how GPs identify FASD.

METHODS

Qualitative study using a grounded theory approach, through semi-structured face-to-face interviews with GPs. Interviews were conducted with the aim of reaching theoretical saturation. These were transcribed verbatim and then analyzed by four researchers to ensure triangulation of the data.

RESULTS

GPs reported barriers to the identification of FASD: challenges in overcoming social taboos and paradoxical injunctions, the influence of limited knowledge and experience, non-specific and highly variable symptoms, ambiguous classification and method of diagnosis involving the mobilization of a multidisciplinary team and lengthy consultations. Conversely, they felt competent to identify neurodevelopmental disorders of any cause, but were concerned about the long waiting time to access specialized care. From the perspective of GPs, it is crucial to prioritize promotion and training aimed at improving the identification and coordination of care pathways for children diagnosed with neurodevelopmental disorders, such as FASD.

General practitioners' practices for malnutrition screening in paediatric populations: a survey in one French department

BACKGROUND

Malnutrition remains a public health problem in Europe, not only in adults, but also in paediatrics. The aim of this study was to evaluate general practitioners (GPs) practices in paediatric malnutrition screening.

METHODS

An anonymised questionnaire was sent to GPs in one French area. We analysed GPs' data: sociodemographic, knowledge of malnutrition screening, practices, tools, and trainings.

RESULTS

Overall, 102 of 174 GPs replied to the questionnaire (58.6%). 79.4% of GPs routinely measured weight, but only 33.3% measured both height and BMI, despite having tools (98,6%). 43.6% of GPs systematically reviewed growth charts. 71.3% were familiar with dietary recommendations, 30.7% with blood tests for nutritional status assessment, and 13.7% with dietary supplements. GPs who routinely measured BMI reviewed significantly more growth charts (p = 0.001) and prescribed more dietary supplements (p = 0.001).

CONCLUSIONS

GPs do not sufficiently measure children's height and BMI, despite the increasing availability of software. Failure to analyse growth charts can induce delays in malnutrition screening.

What are key factors influencing malnutrition screening in community-dwelling elderly populations by general practitioners? A large cross-sectional survey in two areas of France

BACKGROUND/OBJECTIVES

Malnutrition is associated with a high morbi-mortality in elderly populations and their institutionalization at an early stage. The incidence is well known despite being often under-diagnosed in primary care. General practitioners (GPs) have a key role in home care. What are the factors affecting malnutrition-screening implementation by French GPs?

SUBJECTS/METHODS

We conducted a cross-sectional survey in two areas in the southeast of France (Savoie and Isère). In May 2008, an anonymized survey was sent by e-mail and/or post to all GPs with a large clinical practice. Two months later, reminder letters were sent. Potential barriers were measured by dichotomous scale. On GPs' characteristics (socio-demographic, medical training, geriatric practice and knowledge), multiple regression logistic was performed to identify others factors affecting malnutrition screening.

RESULTS

In all, 493 GPs (26.85%) answered and 72.2% felt that malnutrition screening was useful although only 26.6% implemented it each year and 11.9% every 2-5 years. The main barriers to the implementation were patient selection (60.4%) and forgetting to screen (26.6%). Minor barriers were lack of knowledge (19.5%) or time (15%). New factors were identified: unsuitable working conditions (19.1%), insufficient motivation (6.8%) or technical support (7.2%). The quality of malnutrition information received was found to be the only promoter of annual screening (odds ratio=1.44 (1.087-1.919); P=0.011).

CONCLUSIONS

This survey is the first in France to reveal GPs' factors affecting malnutrition implementation. New obstacles were identified in this survey. The hope of implementing regular malnutrition screening by GPs seems to lie with the quality of malnutrition information received.

Understanding change in medical practice: the role of shared meaning in preventive treatment

Health care organizations are experiencing a rising demand for change in the organization of preventive health services. Many initiatives designed to cater for change fail to achieve their aim. To understand how organizational dynamics in health care organizations influence the adoption of new initiatives, I explored the implementation of motivational interviewing, a health behavior concept that was introduced into ten general practice clinics in Denmark. Within an institutional framework I explored how modern ideas of prevention related to this concept were translated into medical practices. Using a qualitative multiple-case study design, I examined the institutionalization process in different clinical settings. I found that clinics constructed various types of preventive routines and thereby imposed new meaning on the health behavior concept. In adopting the concept, clinics developed a new routine against the background of existing practice, (re)producing an alternative, self-contained routine that diverged from their usual medical practice.