COVID-19 psychological impact in general practitioners: A longitudinal study

INTRODUCTION

COVID-19 may have negatively impacted the mental health of front-line healthcare workers, including general practitioners (GPs). This study sought to assess the psychological impact (stress, burnout and self-efficacy) of the COVID-19 outbreak in French GPs.

METHODS

We carried out a postal-based survey of all GPs who worked in the French region of Normandy (departments of Calvados, Manche and Orne) from the exhaustive database of the Union Régionale des Médecins libéraux (URML Normandie) as of 15th April 2020 (one month after the first French COVID-19 sanitary lockdown). The second survey was conducted four months later. Four validated self-report questionnaires were used at both inclusion and follow-up: Perceived Stress scale (PSS), Impact of Event Scale-revised (IES-R), Maslach Burnout Inventory (MBI) and General Self-Efficacy scale (GSE). Demographic data were also collected.

RESULTS

The sample consists of 351 GPs. At the follow-up, 182 answered the questionnaires (response rate: 51.8%). The mean scores of MBI significantly increased during follow-up [Emotional exhaustion (EE) and Personal accomplishment, P<0.01]. Higher burnout symptoms were found at the 4-month follow-up in 64 (35.7%) and 86 (48.0%) participants (43 and 70 participant at baseline), according respectively to EE and depersonalisation scores (P=0.01 and 0.09, respectively).

CONCLUSION

This is the first longitudinal study that has shown the psychological impact of COVID-19 in French GPs. Based on validated a self-report questionnaire, burnout symptoms increased during follow-up. It is necessary to continue monitoring psychological difficulties of healthcare workers especially during consecutive waves of COVID-19 outbreak.

[Dermatologic diseases and healthcare pathway among pregnant women]

OBJECTIVE

Make an inventory of skin lesions during pregnancy and obtain visibility on healthcare pathway among these women in order to identify more precisely the role of the general practitioner (GP).

METHODS

Prospective, observational study, using a self-administered questionnaire among all women in immediate postpartum period between April 2021 and August 2021, relating to pre-existing skin lesions or rashes that appeared during pregnancy, and the description of the healthcare pathway among these women.

RESULTS

The questionnaire was collected in 377 women with a mean age of 30.6±3.7 years, 88.6% had fair skin and 14.6% were smokers. Among them, 35 (9.3%) declared skin diseases prior to pregnancy, of which 22 had a history of atopic eczema. During pregnancy, 136 women (36.1%) declared having skin lesions, the most frequent of which were stretch marks (63.2%) and hyperpigmentation (26.5%), and mainly during the 2^nd trimester (47.0%). Among these 136 women, only 59 (43.4%) referred it to a health care professional who was in 47.4% of cases (28/59) their GP and in 76.3% (45/59) of cases during a pregnancy follow-up appointment.

CONCLUSION

This study showed that skin lesions during pregnancy were frequent and that the majority of these women consulted their GP.

[Screening and management of endometriosis by primary care physicians]

OBJECTIVE

Analyze knowledge and practices of general practitioners concerning the screening and treatment of endometriosis in primary care.

METHODS

Observational study carried out with general practitioners in a healthcare area using an anonymous online questionnaire about symptoms, screening and their management of endometriosis. Responses were analyzed according to the general practitioners' sex, age and practice in gynecology.

RESULTS

Sixty-nine general practitioners (69/458 ; 15.1%) responded. Women (18.4% vs. 9.7% : P=0.02), between 40 and 59 years old (26.5% vs. 0 ; P<0.01), with additional training in gynecology (27.2% vs. 3.0%; P<0.01) had significant activity in gynecology. Typical symptoms of endometriosis were experienced by 76.8% general practitioners, but only 36% "often" or "always" referred to endometriosis when faced with these symptoms. Additional training in gynecology, mostly carried out by women, between 40 and 59 years old, had a positive impact on the evocation of endometriosis in the face of these symptoms. If endometriosis was suspected, 72.5% GPs immediately ordered pelvic ultrasound and 85.5% for analgesics, but 42% referred the woman to a gynecologist.

CONCLUSION

The general practitioner has a key role in the screening and initial management of endometriosis in primary care. The practice and continuing education of general practitioners in gynecology has a significant impact in improving the screening and initial management of endometriosis.

[The role of the general practitioner in management of psychiatric disorders]

AIM

Psychiatric disorders represent a huge burden of disease worldwide. Significant gaps in their diagnosis and treatment remain. In Morocco, an observed shortage of psychiatrists would logically call for their collaboration with family physicians. Our objectives were to analyse perceptions of general practitioners' capacity to manage psychiatric disorders, to study the difficulties encountered in their management of these pathologies, and to assess their degree of collaboration with existing mental health structures.

METHODS

A cross-sectional nationwide survey of family physicians practicing in urban and rural areas in the private and public sectors in the Kingdom of Morocco was organised. Carried out over a period of 10 months (April 2016 to January 2017), the study was based on an anonymised self-administered questionnaire comprising 23 items. Were excluded from the sample: physicians who had tested the questionnaire prior to its distribution, medical students, family physicians employed in administrative services, resident doctors in university hospitals, and questionnaires with incomplete answers.

RESULTS

All in all, five hundred and four questionnaires were distributed, with a participation rate of 79.8%, while 57.9% of the respondents were men. Their seniority as doctors ranged from 1 year to 60 years with average duration of 19.5±11 years. An overwhelming majority of the doctors had obtained their doctorates in Morocco, while 8.4% had been trained abroad. The majority of the doctors surveyed worked in private practice in urban areas (53.1%), and most of them (81.9%) agreed that the management of psychiatric disorders is a public health priority. The participating physicians stated that they received an average of five patients per day suffering from mental disorders, representing 17.3% of their medical consultations. According to their perceptions, the most frequent psychiatric pathologies were depression, somatoform disorders and sleep disturbances, which were cited by 92.9%, 78.8% and 78.5% of them respectively. Regarding the diagnosis of psychiatric pathologies, 60.2% of the doctors considered bipolar disorder as a difficult pathology to diagnose, followed by schizophrenia, autism and dementia, while the pathologies reported as the most difficult to treat were addictive behaviours, schizophrenia, bipolar disorder, autism and dementia. Physicians felt a need for training, primarily pertaining to anxiety disorders, schizophrenia and bipolar disorders (49.5%, 35% and 33.7%, respectively). Nearly a quarter of the respondents (22.4%) mentioned a need for training in management of all psychiatric illnesses. Regarding the reasons for their referral of patients to mental health care structures, 65.4% of the physicians justified their doing so by a need for hospitalisation, while in 43.7% of cases, the transfer was carried out at the request of the patient or his family. The difficulties mentioned by the respondents were firstly a lack of adapted means of care (77.5%), followed by their insufficient training in mental healthcare (52.4%) and absence of collaboration with mental health professionals (52.4%).

CONCLUSION

For the majority of the physicians surveyed, psychiatry represented a public health priority, and their prioritising provides a probable explanation for their positive perception of their role in the management of mental disorders. However, we went on to observe that a number of difficulties constituted obstacles to their role in management of mental disorders and induced them to refer their patients to psychiatrists. Our analysis highlighted the impact of continuing education on physicians' attitudes and the interest of collaboration between practitioners. Efforts in university teaching and continuous education should be encouraged in view of enabling family physicians to more effectively cope with the demands of daily practice and meet the expectations of the overall population.

[Prevention of genetic diseases : the return of the family practitioner ?]

BACKGROUND

Information to kin is one of the major ethical problems of the new genetics. In France, the revised bioethics law in 2011 created the possibility for patients to authorize professionals, under certain conditions, to directly contact their relatives at risk. Beyond this, other actors, such as GPs, could however play a role in this process.

METHODS

Our article is based on an ethnographic-type sociological study by observations and semi-structured interviews with patients (n=59) and genetic professionals (n=16) that took place from 2014 to 2016 in three genetic hospital wards in France and Canada. It focuses particularly on genetic predispositions to breast and ovarian cancers as well as genetic hemochromatosis.

RESULTS

Because of its position as a primary care specialist, the general practitioner can play a decisive role in the process of informing relatives about genetic disorders. Upstream of the genetic test, the generalist, thanks to his knowledge of the family context of his patients, can play a referral role towards a specialized consultation. Downstream, it can also ensure a more effective follow-up of the information procedures undertaken by its patients thanks to the medical follow-up that it carries out.

CONCLUSION

The data collected during our study highlight the unprecedented place that could be that of the general practitioner in the field of prevention in genetics. At the articulation between primary care and highly specialized care, it is the figure of the "family" doctor who seems to be called here to be renewed by genetics.

[Correspondence between general practitioners and cardiologists: Consensus from a study Delphi]

AIM OF THE STUDY

To obtain a consensus from a panel of experts (GP and cardiologists) on the elements to appear on the correspondence sent by GP at the patient's first consultation with the cardiologist and on the response of the cardiologist.

METHOD

A list of proposals concerning the content of the exchanges between the GP and the cardiologist was established by a scientific council of three GPs and one cardiologist, based on a review of the literature and their practices. This list was submitted for evaluation to a panel of GP and cardiologists experts using the modified RAND/UCLA Delphi method.

RESULTS

Twenty nine experts (16 MG and 13 cardiologists) participated in the two evaluation rounds. For the contents of the letter written by the GP, 11 themes have reached consensus: administrative data, reason for consultation, history of the disease, recent constants, current treatments, current or previous pathologies and cardiovascular risk factors, physical activity, psychosocial context, test results, question asked to the cardiologist, cardiologist's perimeter of action. For the contents of the letter of the cardiologist's response, 11 themes were agreed: administrative data, reason for consultation, previous information, clinical examination, ECG, ultrasound, other complementary examinations, answer to the question asked by the GP, dietary treatments, proposed treatments, proposal for follow-up and management.

CONCLUSION

This study have reached consensus on the elements to appear on the letters exchanged between the GP and the cardiologist.

[Is the orientation of patients suffering from depressive disorder to the psychiatric emergencies by a general practitioner associated with the decision to hospitalize?]

INTRODUCTION

Depressive disorders affect nearly 350 million people worldwide and are the world's leading cause of incapacity. Patients who are depressed preferentially approach their general practitioner (GP), who is their first point of contact, in 50-60% of cases. The aim of our study is to assess whether the orientation of patients suffering from anxiety-depressive disorder towards a GP in a general emergency is a factor associated with hospitalization when compared to patients who present themselves spontaneously for the same disorders. Our secondary objective was to identify the different profiles of patients who were hospitalized for these disorders as an emergency.

MATERIALS AND METHODS

We conducted a cross-sectional study for the year 2015, targeting patients who presented as general emergencies at the centre hospitalier de Troyes and who had received a psychiatric diagnosis in the context of an anxiety or depressive disorder.

RESULTS

Five hundred and twenty four patients were included. A univariate analysis showed that referral by the attending physician was associated with hospitalization in 57.9% vs. 42.1% cases (P=0.007), at an odds ratio at 1.98 [1.22-3.21] by multivariate analysis. Analysis by ascending hierarchical classification made it possible to identify 3 profiles for hospitalized patients: 1) patients with a known psychiatric history, a history of past or current follow-ups directed by a psychiatrist, with at least one psychotropic treatment, the presence of psychotic symptoms and a low suicidal risk compared to the rest of the study population; 2) patients without a psychiatric history, or a history of past or ongoing psychiatric follow-up and the absence of ongoing psychotropic treatment. These patients were referred by a GP (67% vs 23%, P<0.001) and their suicidal risk was higher (59% vs 26%, P<0.001); 3) patients about whom the psychiatrist had little information at the time of the emergency consultation.

CONCLUSIONS

The relevance of GPs in orientation towards emergencies pleads in favor of a partnership and an early exchange between treating physicians and the psychiatrists.

[Prospective study of the factors associated with the acceptance of generics substitution by patients and their liberal doctors]

BACKGROUND

Many prescribers and patients remain reluctant to substitution to generics.

METHODS

We conducted a prospective observational study, using semi-structured interviews adapted to identify factors independently associated with the acceptance of alternative to a generic drug by doctors and patients.

RESULTS

Between December 2014 and August 2015, 108 patients and 73 private doctors from Île-de-France and Nord-Pas-de-Calais were enrolled. Only 48 % of patients thought that the effectiveness and safety of generic were identical to the brand-name, 50 % had a favorable opinion and 36 % said they routinely accept substitution, especially when substitution was proposed by the general practitioner (68 % of patients). Age, gender, occupational status and the presence of a chronic condition were not associated to acceptance of substitution (P>0, 1), unlike the opinion (P<0.001), perception of efficacy (P<0.001) and side effects (P=0.0005). Two thirds of physicians substituted more than 50 % of their brand name prescription to generics. This low figure was due to patient request not to substitute (63.9 %).

CONCLUSION

The acceptance of substitution was independently associated to patient' opinion about generic drugs, further emphasizing the need for information campaigns dedicated to patients.

General practitioners and vaccination of children presenting with a benign infection

PURPOSE

To assess the self-reported vaccination behavior of general practitioners (GPs) when asked whether they would recommend the vaccination of a child presenting with a febrile uncomplicated common cold.

METHODS

We performed a cross-sectional survey in 2014 on a national sample of GPs. GPs were randomly assigned to one of eight clinical vignettes, all describing a child presenting with an uncomplicated febrile common cold, but differing by age (4 or 11 months), temperature (38°C or 39°C), and the mother's emotional state (calm or worried). GPs were asked whether they would recommend immediate vaccination of the child with a hexavalent vaccine (diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b, and hepatitis B), or postpone it. We investigated the relation between the GPs' recommendation to vaccinate, the clinical vignette's variables, and the GPs' perceptions, attitudes, and practices toward vaccination in a multivariate model.

RESULTS

Among the 1582 participating GPs, 6% recommended immediate vaccination. This behavior was more frequent with a temperature of 38°C rather than 39°C (10% vs. 3%, P<0.001). GPs who felt comfortable giving explanations about vaccine safety were more likely to recommend immediate vaccination of the febrile child (P=0.045), but none of the other GPs' characteristics were associated with their vaccination behavior.

CONCLUSIONS

Almost all GPs postponed the hexavalent vaccination of the febrile child presenting with an uncomplicated viral disease; fever being the major factor affecting their decision. More research is needed on vaccination responses in sick children, as well as clearer guidelines.

[Indoor air quality and parents of asthmatic children practices]

BACKGROUND

Indoor air pollution can worsen asthma in children. Better knowledge of factors determining parents' reception of recommendations to limit pollution of indoor air in the homes of asthmatic children would be helpful to improve implementation.

METHOD

A descriptive study evaluating practices known to have an impact on the quality of air in homes was conducted among parents of asthmatic children aged 3 to 16 years. From May to September 2013, parents answered anonymous self-administered questionnaires in waiting rooms of generalist practitioners, in the Nantes University pneumology pediatric outpatient clinic, and as part of therapeutic education sessions conducted by the Asthma-44 Network.

RESULTS

There were 190 exploitable questionnaires: 88.2% of parents reported never smoking in the home; 48.4% used home fragrance in the living room at least once a week; 77.8% opened their children's bedroom windows more than 10minutes at least once a day; 32.6% used several cleaning products or bleach once or twice a week. Good practices concerning smoking in housing were applied less in homes where the child was monitored only by a general practitioner (OR=0.08; CI[0.02-0.34]). Good practices on the use of perfume were statistically linked to having an intermediate level occupation (OR=2.31; CI[1.01-5.32]) and being followed by the university hospital, by the asthma network or by a general practitioner if the child had already consulted a pneumo-pediatrician or an allergist (OR=0.24; CI[0.07-0.81]). Good ventilation practices forchildren's bedrooms were statistically linked to residing in a rural rather than urban setting (OR=4.72; CI[1.0-22.16]).

CONCLUSION

Practices observed in parents of asthmatic children differ little from those of the general population. Recommendations on how to limit sources of chemical pollutants, with the exception of smoking, are still poorly applied. Specialist consultations and specific training for general practitioners should improve the penetration of public health messages to this vulnerable population.

[Perception of adverse reactions of chemotherapy and hormone therapy by women treated for breast cancer]

INTRODUCTION

In Europe, breast cancer is the most common cancer among women. His treatment (TTT) can have a significant impact on daily life.

AIMS

Explore the experienced short-term side effects (SE) of chemotherapy and hormonal therapy by women themselves, the information delivered and the place of the general practitioner (GP).

METHOD

Qualitative study by individual interview, conducted from January to May 2015, with 14 women followed for no metastatic breast cancer after chemotherapy and possible initiation of hormone therapy, at the Cancer Institute of the Loire (France).

RESULTS

The SE of chemotherapy, except vomiting, have appeared very trying (fatigue, pains oral and cutaneous involvement), punctuated and accentuated by the cures. They were resounding on daily life, requiring family or professional assistance. Falling dander, considered stigmatizing, violated the person and femininity. The women have estimated to be well informed. They had appreciated the initial response of the pivot nurse. The least expected SE of hormone therapy, hot flashes and articular pains might limit activities. To counteract these side effects, mostly accepted to prevent recidivism, a remedy for complementary therapies was frequent. The GP was solicited for some SE, sometimes for complementary medicine (CM).

CONCLUSION

Over the cures, women suggested support meetings, a more sustainable action of the pivot nurse, a better attention to their complaints and a more personalized information. The development of TTT less EI provider was desired. The effect of CM on SE should be explored.

[Role of general practitioners in cancer screening: A survey in the French armed forces]

INTRODUCTION

The French Military Health Service organizes medical survey of 340,000 military men. The aim of the present study was to evaluate the practices of solid cancer screening of general practitioners in military medical units and to compare the results with the recommendations of the French National Institute of Cancer.

METHODS

We conducted a prospective, observational study among general practitioners in Army Medical Unit by sending them a self-assessment questionnaire. Physicians should report on their practices for screening cancers with official screening recommendations. Compliance rates with the recommendations were reviewed. Screening practices for other cancers (prostate cancer, melanoma, thyroid cancer, lung cancer, testicular cancer) were assessed.

RESULTS

A total of 133 questionnaires were analyzed. Despite a strong involvement of army general health practitioners, guidelines adherence rates (examination frequency, ages of screening beginning and ending) were of 4% for cervical cancer, 7% for breast cancer, and 37% for colorectal cancer. Those rates are comparable to those reported with civilian general practitioners. For cancers without screening recommendation, practitioners felt highly concerned, especially for the most common cancers among the military population. One third of physicians stated that they had diagnosed a testicular cancer through routine screening.

CONCLUSION

Military general health practitioners feel themselves concerned by solid cancer screening, and more particularly for cancers that are the most prevalent in young adults. However, current guidelines are neither known nor applied in routine.

[Objectives and organization for the long-term follow-up after childhood cancer]

Increased survival of patients with childhood cancer has resulted in a growing population of survivors. In France approximately 50,000 alive people have been treated before 20 years old and, as survivors, are at risk for health problems due to disease or cancer therapy (surgery, chemotherapy, radiotherapy). Complications such as cardiovascular or cerebrovascular disease (after radiotherapy or chemotherapy), neurocognitive deficiency, endocrine disorders (hypopituitary axis, or thyroid dysfunction), gonadal function, and second malignancy can be life-threatening and seriously affect quality of life. Upon discharge former patients should be given 'passport', containing a summary of their medical history, treatment (surgery, chemotherapy cumulative doses, characteristics of radiotherapy and organs involved), methods used to preserve fertility, and complications during treatment. Treatments can then be linked to individualized recommendations for follow-up care. The risk of developing long-term complications increases with time and can be aggravated by age-related comorbidity and environmental factors (tobacco, alcohol, obesity). Many regions and treatment centres in France have in place organised long-term follow-up procedures.

[Feasability study of screening for malignant lesions in the oral cavity targeting tobacco users]

INTRODUCTION

Oral cavity cancer is frequent. Prognosis of this cancer is closely linked to the development. Although the oral cavity is a potentially accessible site for examination, up to 50% of oral cancers are not detected until the disease is well advanced.

PATIENTS AND METHOD

In a region where incidence rate is particularly high, local teams involved in screening, in epidemiological survey, in diagnosis and treatment of oral cancer performed a pilot feasibility study to improve strategy of early detection of oral cancer and premalignant lesion. Tobacco venders were solicited to distribute a flyer, which invite smokers to a free examination by general practitioner. General practitioners were invited to examine smokers, and to fill a predeterminate systematic oral cavity examination record during 3 months. They were asked to refer to a specialist if there was a potentially malignant disorder.

RESULTS

The involvement of tobacco venders was rated as 67.3%. Ninety-three patients were included in 3 months. General practitioners referred 27% of the examinated patients. Among them, only 63.6% really saw a specialist, and a premalignant lesion was confirmed in 15.3%; further exams were carried out in 28.6%; a benign lesion was diagnosed in 57.1%.

DISCUSSION/CONCLUSION

Original incentives for oral cavity screening were performed, based on multidisciplinary network. Nevertheless, it remains hardship to reach the targeted population and to maintain the patients in health system.

[Experiences of main caregivers helping patients suffering from lung cancer and position assigned to general practitioners]

INTRODUCTION

Cancer turns into a chronic disease. Its impact on patient's daily life may require the assistance of caregiver.

AIMS

To explore the experiences of main caregivers (MCs) helping patients suffering from lung cancer (LC), and to explore the role and the position assigned to general practitioners (GPs).

METHOD

Qualitative study using semi-directive interviews with 13 PCs, recruited in Roanne's hospital and the Cancer Institute Lucien-Neuwirth (Rhône-Alpes), conducted from February to May 2014.

RESULTS

MCs' life was affected on a social, family, and professional level. Despite a need of listening and support, they remained behind, by devotion. GPs' were care managers, and were found out empathic, compassionate and reassuring. Present at the cancer announcement and viewed as an actor at the end of life, their functions were variable, following MCs during the treatment phase. During this phase, some of them perceived that lack of time, expertise and/or information seemed to be an obstacle to their solicitations.

CONCLUSION

GPs' regular care could improve MCs' quality of life. Telemedicine could facilitate communication between GPs and hospital staff asked by the MCs.

[Seasonal influenza vaccination coverage of general practitioners and their patients. Practice survey of French general practitioners after vaccination campaign 2011-2012]

BACKGROUND

In France, vaccination coverage against seasonal influenza for risk groups was inadequate: 55.2% of people aged 65 and older, and 33% of the 16-64 year group with chronic targeted disorders were vaccinated in March 2012. Three quarters of general practitioners were vaccinated. Our objective was to estimate the influence of the vaccination status of general practitioners on vaccine coverage of their patients at risk.

METHODS

A questionnaire was sent in March 2012 to a sample of 500 general practitioners. Their professional characteristics, vaccination status against seasonal influenza and the determinants of these vaccinations were collected and compared to the vaccine coverage of their patients obtained from the French healthcare fund.

RESULTS

Self-reported vaccination coverage of the 225 general practitioners respondents was 81.3%. There was a positive correlation with age greater than 50 years, high activity level, rural practice and the absence of particular mode of exercise. The doctors wanted to be vaccinated to protect themselves and protect their patients or their family. Of the 42 doctors unvaccinated, 42.5% feared the side effects of the vaccine, 40% considered influenza to be a benign illness and 32.5% considered low risk of catching or spreading it. The vaccination rate for patients aged 65 and older was 62.3% among 147 doctors vaccinated versus 58.3% in unvaccinated 31 physicians (P<0.0001). These rates were 39% versus 36.7% (P=0.29) for patients with chronic targeted disorders.

CONCLUSION

This study shows a positive association between the reported vaccination of general practitioners and effective influenza vaccination of their patients aged 65 years and older. This result is less clear for patients with chronic targeted disorders. All this findings argue in favor of promoting seasonal influenza vaccination among general practitioners.

[Which definition and taxonomy of incident to use for a French reporting system in primary care settings?]

BACKGROUND

There is no widely accepted definition of incident for primary care doctors in France and no taxonomic classification system for epidemiological use. In preparation for a future epidemiological study on primary care incidents in France (the ESPRIT study), this work was designed to identify the definitions and taxonomic classifications used internationally along with the usual methods and results in terms of frequency in the literature. The goal was to determine a French definition and taxonomy.

DESIGN

Systematic review of the literature and consensus methods.

METHOD

An exhaustive search of epidemiological surveys was performed. A structured grid was used. After having identified the definitions used in the literature, a definition was chosen using the focus groups method. Taxonomies identified in the literature were classified by relationship, architecture, code number, and number of studies published. Subsequently, a consensus among experts, who independently tested these taxonomies on six incidents, was reached for choosing the most appropriate for epidemiological data collection (little information on a large number of cases).

RESULTS

Twenty-four papers reporting 17 studies were selected among 139 articles. Five definitions and eight taxonomies were found. The chosen definition of incident was based on the WHO definition "A patient safety incident is an event or circumstance that could have resulted, or did result, in harm to a patient, and whose wish it is not repeated again". The test of incidents resulted in the choice of the TAPS version of the International Taxonomy of Medical Error in Primary Care for a reproducible and internationally recognized codification and the tempos method for its current use in French general practice.

DISCUSSION

The definitions, taxonomies, data collection characteristics and frequency of incidents results in the international literature on incidents in primary care are key components for the preparation of an epidemiological survey on incidents in primary care.