Zaytseva
Anna Zaytseva
Publications
Background:
Cooperation between general practitioners (GPs) and other healthcare professionals appears to help reduce the risk of polypharmacy-related adverse events in patients with multimorbidity.
Objectives:
To investigate GPs profiles according to their opinions and attitudes about interprofessional cooperation and to study the association between these profiles and GPs’ characteristics.
Methods:
Between May and July 2016, we conducted a cross-sectional survey of a panel of French GPs about their management of patients with multimorbidity and polypharmacy, focussing on their opinions on the roles of healthcare professionals and interprofessional cooperation. We used agglomerative hierarchical cluster analysis to identify GPs profiles, then multivariable logistic regression models to study their associations with the characteristics of these doctors.
Results:
1183 GPs responded to the questionnaire. We identified four profiles of GPs according to their declared attitudes towards cooperation: GPs in the ‘very favourable’ profile (14%) were willing to cooperate with various health professionals, including the delegation of some prescribing tasks to pharmacists; GPs in the ‘moderately favourable’ profile (47%) had favourable views on the roles of health professionals, with the exception for this specific delegation of the task; GPs from the ‘selectively favourable’ profile (27%) tended to work only with doctors; GPs from the ‘non-cooperative’ profile (12%) did not seem to be interested in cooperation. Some profiles were associated with GPs’ ages or participation in continuing medical education.
Conclusion:
Our study highlights disparities between GPs regarding cooperation with other professionals caring for their patients and suggests ways to improve cooperation.
Background:
Given the importance of the continuous follow-up of chronic patients, we evaluated the performance of French private practice general practitioners (GPs) practicing in multi-professional group practices (MGP) regarding chronic care management during the first Covid-19 lockdown in Spring 2020 compared to GPs not in MGP. We consider two outcomes: continuity of care provision for chronic patients and proactivity in contacting these patients.
Methods:
The cross-sectional web questionnaire of 1191 GPs took place in April 2020. We exploit self-reported data on: 1) the frequency of consultations for chronic patients during lockdown compared to their "typical" week before the pandemic, along with 2) GPs' proactive behaviour when contacting their chronic patients. We use probit and bivariate probit models (adjusted for endogeneity of choice of engagement in MGP) to test whether GPs in MGP had significantly different responses to the Covid-19 crisis compared to those practicing outside MGP.
Results:
Out of 1191 participants (response rate: 43.1%), around 40% of GPs were female and 34% were younger than 50 years old. Regression results indicate that GPs in MGP were less likely to experience a drop in consultations related to complications of chronic diseases (- 45.3%). They were also more proactive (+ 13.4%) in contacting their chronic patients compared to their peers practicing outside MGP.
Conclusion:
We demonstrate that the MGP organisational formula was beneficial to the follow-up of patients with chronic conditions during the lockdown; therefore, it appears beneficial to expand integrated practices, since they perform better when facing a major shock. Further research is needed to confirm the efficiency of these integrated practices outside the particular pandemic setup.
Disparities in physicians' geographical distribution lead to highly unequal access to healthcare, which may impact quality of care in both high and low-income countries. This paper uses a 2013–2014 nationally representative survey of French general practitioners (GPs) matched with corresponding administrative data to analyze the effects of practicing in an area with weaker medical density. To avoid the endogeneity issue on physicians' choice of the location, we enriched our variable of interest, practicing in a relatively underserved area, with considering changes in medical density between 2007 and 2013, thus isolating GPs who only recently experienced a density decline (identifying assumption). We find that GPs practicing in underserved areas do shorter consultations and tend to substitute time-consuming procedures with alternatives requiring fewer human resources, especially for pain management. Results are robust to considering only GPs newly exposed to low medical density. Findings suggest a significant impact of supply-side shortages on the mix of healthcare services used to treat patients, and point to a plausible increased use of painkillers, opioids in particular.
Background:
GPs are confronted with therapeutic dilemmas in treating patients with multimorbidity and/or polypharmacy when unfavourable medication risk–benefit ratios (RBRs) conflict with patients’ demands.
Aim:
To understand GPs’ attitudes about prescribing and/or deprescribing medicines for patients with multimorbidity and/or polypharmacy, and factors associated with their decisions.
Design and setting:
Cross-sectional survey in 2016 among a national panel of 1266 randomly selected GPs in private practice in France.
Method:
GPs’ opinions and attitudes were explored using a standardised questionnaire including a case vignette about a female treated for multiple somatic diseases, sleeping disorders, and chronic pain. Participants were randomly assigned one of eight versions of this case vignette, varying by patient age, socioprofessional status, and stroke history. Backward selection was used to identify factors associated with GPs’ decisions about drugs they considered inappropriate.
Results:
Nearly all (91.4%) responders felt comfortable or fairly comfortable deprescribing inappropriate medications, but only 34.7% decided to do so often or very often. In the clinical vignette, most GPs chose to discontinue symptomatic medications (for example, benzodiazepine, paracetamol/tramadol) because of unfavourable RBRs. When patients asked for ketoprofen for persistent sciatica, 94.1% considered this prescription risky, but 25.6% would prescribe it. They were less likely to prescribe it to older patients (adjusted odds ratio [AOR] 0.48, 95% confidence interval [CI] = 0.36 to 0.63), or those with a stroke history (AOR 0.55, 95% CI = 0.42 to 0.72).
Conclusion:
In therapeutic dilemmas, some GPs choose to prioritise patients’ requests over iatrogenic risks. GPs need pragmatic implementation tools for handling therapeutic dilemmas, and to improve their skills in medication management and patient engagement in such situations.
[FR]
Selon les projections récentes, les effectifs de médecins libéraux diminueront de 30 % d’ici à 2027 et la densité standardisée diminuerait jusqu’en 2023, créant des poches de sous-densité relativement nombreuses sur le territoire français métropolitain. L’article s’intéresse aux ajustements que les médecins généralistes de ville mettent en œuvre lorsque, sur leur territoire, ils sont d’ores et déjà confrontés à cette raréfaction. Les données utilisées sont celles du troisième panel des médecins généralistes enrichies d’indicateurs fournis par la CNAMTS. Nous nous sommes appuyés sur l’indicateur d’accessibilité potentielle localisé, développé par l’IRDES et la DREES, pour définir les zones les moins dotées en généralistes. En comparant les comportements des généralistes exerçant dans les zones les moins dotées à leurs homologues des zones mieux dotées, il est apparu d’abord que le planning d’activité du médecin tend à s’intensifier plutôt qu’à s’allonger. Nos données semblent en effet montrer que les rythmes de consultation dans les zones les moins dotées sont plus élevés, alors que le temps de travail global des généralistes s’avère quant à lui peu réactif à la densité en médecins alentour. On note aussi quelques différences statistiquement significatives sur les pratiques médicales : usage accru de certains médicaments, moins de renvoi vers des soins paramédicaux, suivis gynécologique probablement un peu moins réguliers, etc. Cependant, il semble que les différences ne sont pas statistiquement significatives pour les indicateurs de qualité des pratiques rattachés au dispositif de rémunération sur objectifs de santé publique (ROSP).
[EN]
According to recent projections, the number of private practice physicians will decrease by 30 % by 2027 and the standardised density will continue to decline up to 2023, thus creating territorial inequalities in physicians’ distribution in mainland France. This article focuses on the adaptations that private general practitioners (GPs) make when they already practice in underserved areas. The data used are those of the third panel of general practitioners matched with indicators provided by the Social Security (CNAMTS). We used the local potential accessibility indicator developed by IRDES and DREES to define the underserved areas for general practitioners. Our results show that GPs’ consultation rhythm is higher in underserved areas, while the overall working-time is not very responsive to the local medical density. We also find some statistically significant differences in practices : more frequent prescription of certain drugs, less referrals to paramedical care, probably less regular gynaecological follow-up, for GPs practicing in underserved areas compared to their counterparts in better-served areas. However, it appears that there are no significant differences regarding the indicators of Rémuneration sur objectifs de santé publique (ROSP) [French supplementary payment-for-performance] program, which could allow a first assessment of the quality of care.
