Paraponaris

Publications

Perceptions and attitudes of French general practitioners towards rapid antigen diagnostic tests in acute pharyngitis using a randomized case vignette studyJournal articleCéline Pulcini, Laure Pauvif, Alain Paraponaris, Pierre Verger et Bruno Ventelou, Journal of Antimicrobial Chemotherapy, Volume 67, Issue 6, pp. 1540-1546, 2012

Objectives This study had three objectives: (i) to assess the use of rapid antigen diagnostic tests (RADTs) and their impact on the antibiotic prescribing behaviour of general practitioners (GPs) for acute pharyngitis; (ii) to study the barriers to the use of RADTs; and (iii) to identify GPs' characteristics associated with non-compliance with French guidelines.Methods We conducted a cross-sectional survey of a representative sample of 369 self-employed GPs in south-eastern France using a randomized case vignette study.Results The availability of an RADT allowed a 44% relative reduction in the rate of antibiotic prescriptions. Of GPs for whom the test was available, 34% did not use an RADT in our acute pharyngitis vignette and 13% of those who used the test prescribed an antibiotic despite a negative RADT result. Non-compliance with French guidelines (i.e. not using an RADT and/or prescribing an antibiotic despite a negative RADT result) was independently associated with the following factors: less reading of medical journals, less benefits/risks discussion with patients about vaccinations and higher perception that clinical examination was sufficient to prescribe antibiotics. The three main declared barriers to RADT use were: time to perform the test, patient expectations regarding antibiotics and the perception that clinical examination was sufficient to decide to prescribe an antibiotic.Conclusions RADTs are a useful but not sufficient tool to reduce antibiotic prescribing in general practice. The results of this study increase understanding of the factors underlying clinical decision making for acute pharyngitis and may contribute to the development of interventions to improve practice.

Fee-for-service payments and consultation length in general practice: a work-leisure trade-off model for French GPsJournal articleIsabelle Clerc, Olivier L’haridon, Alain Paraponaris, Camelia Protopopescu et Bruno Ventelou, Applied Economics, Volume 44, Issue 25, pp. 3323-3337, 2012

This article presents an adaptation of the labour supply model applied to the independent medical sector. First, we model simultaneous General Practitioner (GP) decisions on both the leisure time and the consultation length for two payment schemes: fixed fees and unregulated fees. The objective of this econometric study is to validate the theoretical prediction that doctors under unregulated fees may make choices about the length of patient consultations independent of their personal leisure decision. Indeed, according to our empirical results, the bidirectional link between leisure choice and consultation length – verified with fixed fees – does not hold any longer under unregulated fees. Our findings can be seen as a necessary but not a sufficient condition to legitimize unregulated fees in general practice.

La médecine générale vue par les médecins généralistes libérauxJournal articleAlain Paraponaris, Bruno Ventelou, Pierre Verger, Pascale Desprès, Catherine Aubry, Carole Colin, Caroline Bonnet, Thomas Hérault, Rémy Sebbah et Yolande Obadia, Revue française des affaires sociales, Issue 2-3, pp. 29-47, 2011
Density of dental practitioners and access to dental care for the elderly: a multilevel analysis with a view on socio-economic inequality.Journal articleLaurence Lupi-Pégurier, Isabelle Clerc-Urmes, Mohammad Abu-Zaineh, Alain Paraponaris et Bruno Ventelou, Health Policy, Volume 103, Issue 2-3, pp. 160-167, 2011

To examine the relations between density of dental practitioners (DDP) and socio-economic and demographic factors shown to affect access to dental care for the elderly.

General practitioners and clinical practice guidelines: a reexamination.Journal articleBruno Ventelou, Alain Paraponaris, Isabelle Clerc, Marc-Andre Guerville et Pierre Verger, Medical Care Research and Review : MCRR, Volume 68, Issue 4, pp. 504-518, 2011

General practitioners' (GPs') use of clinical practice guidelines (CPGs) may be influenced by various contextual and attitudinal factors. This study examines general attitudes toward CPGs to establish profiles according to these attitudes and to determine if these profiles are associated with awareness and with use of CPGs in daily practice. The authors conducted a cross-sectional telephone survey of 1,759 French GPs and measured (a) their general attitudes toward CPGs and (b) their awareness and use in daily practice of CPGs for six specific health problems. A bivariate probit model was used with sample selection to analyze the links between GPs' general attitudes and CPG awareness/use. The authors found three GP profiles according to their opinions toward CPGs and a positive association between these profiles and CPG awareness but not use. It is important to build awareness of CPGs before GPs develop negative attitudes toward them.

Job tenure and self-reported workplace discrimination for cancer survivors 2 years after diagnosis: Does employment legislation matter?Journal articleAlain Paraponaris, Luis Sagaon Teyssier et Bruno Ventelou, Health Policy, Volume 98, Issue 2-3, pp. 144-155, 2010

Objectives To assess the risk of leaving employment for cancer survivors 2 years after diagnosis and the role of workplace discrimination in this risk.Methods A representative sample of 4270 French individuals older than 17 and younger than 58 years when diagnosed with cancer in 2002 were interviewed 2 years later. Their occupational status was analyzed with the help of Probit and IV-Probit models.Results Overall, 66% of the cancer survivors who were working at the time of diagnosis were still employed 2 years later. Age, education level, income at diagnosis, work contract, professional status, affective support, relative prognosis at diagnosis, tumor site and treatment have contrasting impacts upon the probability of job loss across gender. Even after having controlled for these variables, self-reported workplace discrimination increases the probability of job loss by 15%.Conclusions Despite protective labor law and favorable health insurance arrangements, French cancer survivors continue to experience problems to stay in or to return to the labor force. Measures targeting only the employment protection of cancer survivors do not seem to be sufficient to end prior social inequalities in job attainment. Intervention for specific populations particularly exposed to job-loss risks would also be needed.

Endogénéité du statut du répondant dans les enquêtes sur la santé. Quelles implications pour la mesure des besoins d'aide ?Journal articleBérengère Davin, Xavier Joutard, Alain Paraponaris et Pierre Verger, Revue Économique, Volume 60, Issue 2, pp. 275-291, 2009

Most of population health surveys appeal to proxy respondents, when surveyed persons with poor health are not able or do not want to answer the questionnaire by themselves. Yet, it may give rise to a strong endogeneity problem since the use of a proxy respondent is likely to be linked to subjects’ health status. That paper aims at giving a convenient and tractable way to cope with the twofold potential endogeneity of the respondent status in the estimation of two probit equations concerning the need for care with daily activities and unmet or undermet need reported by people aged 60 years and over living in the community. Unlike previous papers dealing with that topic, evidence is found that proxy respondents do not entail any subjectivity when they assess old people’s need for care but they seem to overestimate undermet and unmet need. Classification JEL : C35 ; I12 ; J14.

Socioeconomic determinants of the need for personal assistance reported by community-dwelling elderly: Empirical evidence from a French national health surveyJournal articleBérengère Davin, Alain Paraponaris et Pierre Verger, Journal of Behavioral and Experimental Economics (formerly The Journal of Socio-Economics), Volume 38, Issue 1, pp. 138-146, 2009

A bivariate probit model with sample selection is used to estimate the conditional probability of reporting a need for personal assistance (NPA) with at least one activity of daily living among French community-dwelling elderly. 71.8% of men and 77.3% of women reported impairments and among those who reported impairments, 7.5% of men and 10.8% of women reported NPA. NPA is associated not only with age (i.e., the oldest individuals, for women only) and health status (such as a specific type of impairment), but also with socioeconomic (living with intermediate income; living with someone, partner or other) and environmental factors (having and using assistive technologies).

Cancer et activité professionnelleJournal articleSophie Eichenbaum-Voline, Laëtitia Malavolti, Alain Paraponaris et Bruno Ventelou, Revue de l'OFCE, Volume 104, Issue 1, pp. 105-134, 2008

Cancer survivors frequently shift to part-time job, unemployment and early retirement, probably more than the general population. We re-evaluated the impact of cancer in the labour market, using ?comparative? transition matrices between occupational states. The proper consequences of cancer were measured by a significant deviation of the transition matrix for cancer survivors, compared to a prior matrix standardised on the general population. The methodology was declined with stratifications by social class or gender. We disentangle whether systematic differences in socioeconomic status regarding ability to return to work, are illness related (cancer sites or diagnosis prognosis), or job related (physical demands). Results of the paper are in favour of a specific concern of the policy-maker towards manual workers affected by cancer. JEL classification: I10 ; J210 ; J24.

Besoins et insuffisance d'aide humaine aux personnes âgées à domicile : une approche à partir de l'enquête « Handicaps, incapacités, dépendance » 1Journal articleBérengère Davin, Xavier Joutard, Jean-Paul Moatti, Alain Paraponaris et Pierre Verger, Sciences sociales et santé, Volume 24, Issue 3, pp. 59-93, 2006