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Richard A, Mariotti B, Piñol-Domenech N, Vorilhon P, Vaillant-Roussel H. Prescription-free consultation in France and Europe: Rates' evolution, physicians' and patients' perceptions from 2005 to 2019, a systematic review. Therapie 2023; 78:733-741. [PMID: 36918318 DOI: 10.1016/j.therap.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/16/2023] [Accepted: 02/24/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND In 2005, the rate of prescription-free consultations in Europe varied widely: 57% in the Netherlands, 28% in Germany, 17% in Spain and 10% in France. OBJECTIVES To assess the number of prescription-free consultations in European countries since 2005 and to analyse the perceptions of patients and general practitioners (GPs). METHODS This was a systematic review of the literature from 2005 to 2019, including both quantitative and qualitative studies on prescription-free consultations. RESULTS Of 13,380 studies, 28 were included. The rates of prescription-free consultations were 30% in Belgium, 41% in Slovenia, 47% in the UK and 22% in France, according to the most recent figures. Swedish GPs estimated their prescription-free consultation rate at 70%. The only significant factor that decreased the number of prescription-free consultations was laboratory visits. According to the qualitative data, the main constraint was lack of time; the main facilitating factor was a shared medical decision. CONCLUSION Medical visits decreased the number of prescription-free consultations. According to qualitative studies, the main barrier was lack of time. The countries with the highest drug consumption levels were those with the lowest number of prescription-free consultations. Achieving prescription-free consultations to combat overmedication and for the quality of care and the environment is a priority. To understand and analyse consultations without prescriptions, a quantitative observational study was launched in France in 2020.
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Affiliation(s)
- Amélie Richard
- Department of General Practice, Clermont-Auvergne University, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France; Research Unit ACCePPT, Clermont-Auvergne University, 63000 Clermont-Ferrand, France; Multiprofessional health centre Batignolles, 63350 Joze, France.
| | - Bruno Mariotti
- Department of General Practice, Clermont-Auvergne University, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France
| | | | - Philippe Vorilhon
- Department of General Practice, Clermont-Auvergne University, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France; Research Unit ACCePPT, Clermont-Auvergne University, 63000 Clermont-Ferrand, France; Clermont-Ferrand University Hospital, DRCI, Biostatistics Unit, 63000 Clermont-Ferrand, France
| | - Hélène Vaillant-Roussel
- Department of General Practice, Clermont-Auvergne University, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France; Research Unit ACCePPT, Clermont-Auvergne University, 63000 Clermont-Ferrand, France; Clermont-Ferrand University Hospital, DRCI, Biostatistics Unit, 63000 Clermont-Ferrand, France
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Schnelle C, Jones MA. Characteristics of Exceptionally Good Doctors: A Protocol for a Cross-Sectional Survey of Adults. Patient Relat Outcome Meas 2022; 13:181-188. [PMID: 35983576 PMCID: PMC9381005 DOI: 10.2147/prom.s376033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/07/2022] [Indexed: 11/23/2022] Open
Abstract
Background Doctors constitute a significant proportion of a very large number of medical interactions. They are known to vary in the quality of their work, with some having an exceptionally beneficial effect on patients’ physical health. In a qualitative study, we interviewed medical doctors on their opinions and experiences of exceptionally good doctors. Their responses and the results from previous research are used as a basis for this proposed cross-sectional survey directed to members of the public on their encounters with exceptionally good doctors. The primary aim of this cross-sectional study is to describe the characteristics of exceptional doctors as reported by a large representative sample of adult patients. Methods and Analysis A mixed qualitative and quantitative anonymous cross-sectional survey of 500 Amazon Mechanical Turk (MTurk) respondents, who have met one or more exceptionally good doctors in their life, will be conducted. Information requested will include reasons for nominating a particular doctor; experience of how that doctor differs from other and average doctors; and 34 5-point Likert scale questions on the characteristics of that doctor and the same Likert questions for the average doctor. An opportunity to report their experience in free-text form will be provided. Sample size will be sufficient to obtain a margin of error of 4%. The authors will provide descriptive statistics, including graphs of the Likert scale question responses; conduct factor analysis for internal validity; investigate satisficing and logical inconsistencies; and explore whether there are multiple types of exceptionally good doctors. Discussion Previous surveys of patients’ perceptions of doctors exist though none have focused on exceptionally good doctors. The expected results will include a list of characteristics that are important to patients in determining exceptionally good doctors.
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Affiliation(s)
- Christoph Schnelle
- Institute of Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
- Correspondence: Christoph Schnelle, Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia, Email
| | - Mark A Jones
- Institute of Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
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Schnelle C, Clark J, Mascord R, Jones MA. Is There a Doctors' Effect on Patients' Physical Health, Beyond the Intervention and All Known Factors? A Systematic Review. Ther Clin Risk Manag 2022; 18:721-737. [PMID: 35903086 PMCID: PMC9314759 DOI: 10.2147/tcrm.s372464] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/11/2022] [Indexed: 01/10/2023] Open
Abstract
Purpose Despite billions of doctor visits worldwide each year, little is known on whether doctors themselves affect patients’ physical health after accounting for intervention and confounders such as patients’ and doctors’ data, hospital effects, nor how strong that doctors’ effect is. Knowledge of surgeons’ and psychotherapists’ effects exists, but not for 102 other medical specialties notwithstanding the importance of such knowledge. Methods Eligibility Criteria: Randomized controlled trials (RCTs), case-control, and cohort studies including medical doctors except surgeons for any intervention, reporting the proportion of variance in patients’ outcomes owing to the doctors (random effects), or the fixed effects of grading doctors by outcomes, after multivariate adjustment. Exclusions: studies of <15 doctors or solely reporting doctors’ effects for known variables. Sources Medline, Embase, PsycINFO, inception to June 2020. Manual search for papers referring/referred to by resulting studies. Risk of Bias Using Newcastle–Ottawa scale. Results Despite all medical interventions bar surgery being eligible, only thirty cohort papers were found, covering 36,239 doctors, with 10 specialties, 21 interventions, 60 outcomes (17 unique). Studies reported doctors’ effects by grading doctors from best to worst, or by diversely calculating the doctor-attributed percentage of patients’ outcome variation, ie the intra-class correlation coefficient (ICC). Sixteen studies presented fixed effects, 18 random effects, and 3 another approach. No RCTs found. Thirteen studies reported exceptionally good and/or poor performers with confidence intervals wholly outside the average performance. ICC range 0 to 33%, mean 3.9%. Highly diverse reporting, meta-analysis therefore not applicable. Conclusion Doctors, on their own, can affect patients’ physical health for many interventions and outcomes. Effects range from negligible to substantial, even after accounting for all known variables. Many published cohorts may reveal valuable information by reanalyzing their data for doctors’ effects. Positive and negative doctor outliers appear regularly. Therefore, it can matter which doctor is chosen. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/uXjR7VOXTwQ
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Affiliation(s)
- Christoph Schnelle
- Institute of Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
| | - Justin Clark
- Institute of Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
| | - Rachel Mascord
- General Dentist, BMA House, Sydney, New South Wales, Australia
| | - Mark A Jones
- Institute of Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
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Schnelle C, Jones MA. The Doctors' Effect on Patients' Physical Health Outcomes Beyond the Intervention: A Methodological Review. Clin Epidemiol 2022; 14:851-870. [PMID: 35879943 PMCID: PMC9307914 DOI: 10.2147/clep.s357927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/22/2022] [Indexed: 01/02/2023] Open
Abstract
Background Previous research suggests that when a treatment is delivered, patients’ outcomes may vary systematically by medical practitioner. Objective To conduct a methodological review of studies reporting on the effect of doctors on patients’ physical health outcomes and to provide recommendations on how this effect could be measured and reported in a consistent and appropriate way. Methods The data source was 79 included studies and randomized controlled trials from a systematic review of doctors’ effects on patients’ physical health. We qualitatively assessed the studies and summarized how the doctors’ effect was measured and reported. Results The doctors’ effects on patients’ physical health outcomes were reported as fixed effects, identifying high and low outliers, or random effects, which estimate the variation in patient health outcomes due to the doctor after accounting for all available variables via the intra-class correlation coefficient. Multivariable multilevel regression is commonly used to adjust for patient risk, doctor experience and other demographics, and also to account for the clustering effect of hospitals in estimating both fixed and random effects. Conclusion This methodological review identified inconsistencies in how the doctor’s effect on patients’ physical health outcomes is measured and reported. For grading doctors from worst to best performances and estimating random effects, specific recommendations are given along with the specific data points to report. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/rvHjVIEPVhI
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Affiliation(s)
- Christoph Schnelle
- Institute of Evidence-Based Healthcare, Bond University, Robina, QLD, 4226, Australia
| | - Mark A Jones
- Institute of Evidence-Based Healthcare, Bond University, Robina, QLD, 4226, Australia
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Schnelle C, Jones MA. Protocol for a Qualitative Study on Doctors' Opinions on and Experiences of Exceptionally Good Doctors. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:103-109. [PMID: 35115858 PMCID: PMC8801328 DOI: 10.2147/amep.s343554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 01/01/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Doctors have a varying effect on patients' physical health. This means that there are doctors that are more effective than others. Even though the doctor is a part of very many medical interactions, it is not known in which way exceptionally good doctors differ from their peers. After authoring two systematic and one methodological review on identifying exceptional doctors, the authors in this qualitative interview-based study take a bottom-up, inductive approach to answer the question of what makes an exceptionally good doctor. METHODS About 10-15 semi-structured interviews of medical doctors of any specialty who speak English will be conducted. Recruitment will be through the authors' network and their referrals. Questions will be whether they have an opinion on what makes an exceptionally good doctor, whether they have met such a person and how did this doctor differ from other doctors. The interviews will be done by a 62-year old PhD student who is not a clinician but has extensive experience in having personal conversations as a financial adviser. This could be helpful as the interviewer is only aware that there are exceptionally good doctors but has no notion how exceptionally good doctors differ from their colleagues. ANALYSIS A six-phase thematic analysis in an experiential framework as per Braun and Clarke will be implemented with the aim to find out what the doctors think and have experienced. This is an inductive approach using a realist epistemological position under the assumption that it is possible to acquire truthful knowledge on what makes exceptionally good doctors. DISCUSSION Previous qualitative research on exceptionally good doctors consisted of interviewing author-selected exceptionally good doctors. This study takes a step back from this approach by asking the peers of exceptionally good doctors how they define being exceptionally good and how they experience such doctors.
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Affiliation(s)
- Christoph Schnelle
- Institute of Evidence-Based Healthcare, Bond University, Robina, QLD, 4226, Australia
| | - Mark A Jones
- Institute of Evidence-Based Healthcare, Bond University, Robina, QLD, 4226, Australia
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Kazzazi F. The automation of doctors and machines: A classification for AI in medicine (ADAM framework). Future Healthc J 2021; 8:e257-e262. [PMID: 34286194 PMCID: PMC8285145 DOI: 10.7861/fhj.2020-0189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The advances in artificial intelligence (AI) provide an opportunity to expand the frontier of medicine to improve diagnosis, efficiency and management. By extension of being able to perform any task that a human could, a machine that meets the requirements of artificial general intelligence ('strong' AI; AGI) possesses the basic necessities to perform as, or at least qualify to become, a doctor. In this emerging field, this article explores the distinctions between doctors and AGI, and the prerequisites for AGI performing as clinicians. In doing so, it necessitates the requirement for a classification of medical AI and prepares for the development of AGI. With its imminent arrival, it is beneficial to create a framework from which leading institutions can define specific criteria for AGI.
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Affiliation(s)
- Fawz Kazzazi
- Mason Institute for Medicine, Life Sciences and Law, Edinburgh, UK
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Chapron A, Brochard M, Rousseau C, Rousseau AC, Brujean M, Fiquet L, Gandemer V. Parental reassurance concerning a feverish child: determinant factors in rural general practice. BMC FAMILY PRACTICE 2018; 19:7. [PMID: 29316903 PMCID: PMC5759265 DOI: 10.1186/s12875-017-0686-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 12/08/2017] [Indexed: 11/26/2022]
Abstract
Background Acute fever is the most common pediatric condition encountered in general practice and a source of parental concern that can result in inappropriate behavior. The main objective of this study was to describe and quantify parental reassurance concerning their feverish child in the context of visits to rural general practitioners (GPs). Method The study included the parents of 202 feverish children, aged from 3 months to 6 years, consulting 13 representative rural GPs. Questionnaires were administered before and after the consultation. Uni- and multivariate analysis were performed to study variations of the levels of concern and associated factors. Results The duration of fever was 1.3 days (± 1.1). The mean score for parental concern was 4.8 out of 10 (± 2.2) before, and 2.4 (± 1.9) after the consultation (p < 0.0001). The concern correlated with the timing of the appointment relative to the usual wait (p = 0.0002), and a lack of knowledge about fever complications (p = 0.013). Conclusion Facilitating access to consultations with a GP within the expected timeframe reduces parental concern. Increasing parental education about fever is also necessary. Electronic supplementary material The online version of this article (10.1186/s12875-017-0686-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anthony Chapron
- Univ Rennes, Department of General Practice, 2 av du Pr Léon Bernard, F-35043, Rennes, France. .,Univ Rennes, CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Clinique de Rennes)], F-35000, Rennes, France.
| | - Marc Brochard
- Univ Rennes, Department of General Practice, 2 av du Pr Léon Bernard, F-35043, Rennes, France
| | - Chloé Rousseau
- Univ Rennes, CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Clinique de Rennes)], F-35000, Rennes, France
| | - Anne-Charlotte Rousseau
- Univ Rennes, Department of General Practice, 2 av du Pr Léon Bernard, F-35043, Rennes, France
| | - Martine Brujean
- Univ Rennes, Department of General Practice, 2 av du Pr Léon Bernard, F-35043, Rennes, France
| | - Laure Fiquet
- Univ Rennes, Department of General Practice, 2 av du Pr Léon Bernard, F-35043, Rennes, France.,Univ Rennes, CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Clinique de Rennes)], F-35000, Rennes, France
| | - Virginie Gandemer
- Univ Rennes, CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Clinique de Rennes)], F-35000, Rennes, France.,CHU, Département d'Hémato-oncologie Pédiatrique, Rennes, France
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Menecier P, Plattier S, Rotheval L, Ploton L. Réflexions sur l’emprise et la possessivité dans la relation de soin en gérontologie. ANNALES MEDICO-PSYCHOLOGIQUES 2016. [DOI: 10.1016/j.amp.2015.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Penner LA, Roger K. The person in the room: how relating holistically contributes to an effective patient-care provider alliance. Commun Med 2013; 9:49-58. [PMID: 23763236 DOI: 10.1558/cam.v9i1.49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this paper is to explore how relating to the 'whole' person--both the physical body and the invisible aspects of the 'self'--is essential in the establishment of a strong therapeutic alliance between patients and health care providers. Our work is based on interviews conducted with individuals affected by neurological illnesses (patients and family care providers). Hsieh and Shannon's (2005) conventional content analysis was used to analyze the data. Under the broad theme of 'maintaining a coherent sense of self' we identified four distinct sub-themes related to interactions with health care providers. The results elucidate the more complex and deep needs of patients who must access care on an ongoing basis, and highlight the important role that care providers play in supporting individuals who are experiencing physical, spiritual and social losses. Care must attend to the deep needs of these individuals by communicating in a style that addresses both emotional and cognitive needs of patients, by thorough and holistic assessment and by appropriate referrals.
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Affiliation(s)
- Leslie A Penner
- Department of Family Social Sciences, University of Manitoba, Winnipeg, Canada.
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The placebo effect: Still under a cloud of confusion. Comments on the update by J.-M. Berthelot. Joint Bone Spine 2011; 78:433. [DOI: 10.1016/j.jbspin.2011.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2011] [Indexed: 11/20/2022]
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Gallois P. La médecine moderne ne se résume pas à un effet pharmacologique. Presse Med 2006; 35:931-2. [PMID: 16783248 DOI: 10.1016/s0755-4982(06)74722-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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