[Show abstract][Hide abstract] ABSTRACT: Objective: To identify what research in general practice represents today in France: results and typology, methods, the group of researchers in general practice, constraints, challenges and perspectives. Method: The analysis of a corpus of 271 research articles obtained from systematic scanning of three French medical journals (published between 1990 and 2000). Results: The number of publications has increased since the early nineties. A total of 161 lead authors were identified, of whom only eight have published more than four articles in eleven years. 121 articles are the result of individual initiatives, 62 are signed by several authors, 44 jointly by an author and an organisation. Applied research focused on professional practice is the main theme (one article out of two). The methods used are predominantly quantitative (8 out of 10 cases). Conclusion: Research in general practice in France is still very limited. This raises two questions: that of the links between general practice and universities and that of the place of general practice within the French healthcare system. There are several issues at stake here: to establish the legitimacy of an autonomous degree course; to provide knowledge that will enhance individual practice and quality of care; to fit into a wider movement on a European and international scale.
[Show abstract][Hide abstract] ABSTRACT: Quantitative studies failed to determine variables which consistently explain adherence or non-adherence to treatment recommendations. Qualitative studies identified issues such as the quality of the health provider-health receiver relationship and the patient's health beliefs. According to these findings, 39 focus groups of 246 people living with type-2 diabetes were conducted in seven European countries, assessing health beliefs, communication with caregivers and problems encountered in adhering to treatment regimens. Meta-ethnography was later applied to make a qualitative meta-analysis. Obstacles to adherence are common across countries, and seem to be related less to issues of the health-care system and more to patient's knowledge about diabetes, beliefs and attitudes and the relationship with health-care professionals. The resulting key themes are course of diabetes, information, person and context, body awareness and relationship with the health care provider. Meta-ethnography is a feasible tool for the meta-analysis of multilingual qualitative data and leads to a richer account.
Primary Care Diabetes 02/2007; 1(1):25-33. · 1.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Public authorities have opted to promote the representation of patients and health system users within health institutions and regional decision-making bodies. This raises one important question: that of the links and mutual benefits between independent primary providers and users' associations. Patients' associations in the health field are not that well-known among doctors, who are in fact only minutely affected by their activities and hence not very aware of them. The improved management of care provision, however, may well give rise to a triangular relationship: patient's association--primary care provider--hospital. The relationship between primary care and associations may largely depend upon hospital-based and delivered medical care. The "independent sector" referred to by these associations often concerns paramedical health professionals rather than independent GPs.
[Show abstract][Hide abstract] ABSTRACT: Confidentiality is a major determinant of the accessibility and acceptability of sexual and reproductive health care for adolescents. Previous research has revealed that Lithuanian adolescents lack confidence in guarantees of confidentiality in primary health care settings. This study aimed to assess the factors that affect general practitioners' decisions whether to respect confidentiality for Lithuanian adolescents under the age of 18. Twenty in-depth interviews were carried out with a purposive sample of general practitioners. The decision whether to respect confidentiality was found to be influenced by external forces, including the legislative framework and societal attitudes towards adolescent sexuality; institutional features in clinical facilities, such as the presence of a nurse during consultations and the openness of the medical record filing system; and individual factors, including GPs' relationships with adolescents' families and their personal attitudes towards sexual and reproductive health issues. The findings reflect the urgent need for a comprehensive policy to ensure adolescents' right to confidentiality in Lithuanian primary care settings, including legislative reforms, institutional changes in health care settings, professional guidelines and (self-)regulation, and changes in medical training and continuing medical education. Other ways to safeguard confidentiality in adolescent health services, such as establishing youth clinics, should also be explored.
Reproductive Health Matters 06/2006; 14(27):129-37. · 1.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Adolescents' consultation of primary health care services remains problematic despite their accessibility. The reproductive health service seeking behavior of adolescents is the object of much research but little is known about how this behavior is influenced by the gatekeeping system. This study aimed to explore general practitioners' perceptions of the appropriateness of gatekeeping in adolescent reproductive health care.
Twenty in-depth interviews regarding factors affecting adolescent reproductive health care were carried out on a diverse sample of general practitioners and analyzed using grounded theory.
The analysis identified several factors that shaped GPs' negative attitude to gatekeeping in adolescent reproductive health care. Its appropriateness in this field was questionable due to a lack of willingness on the part of GPs to provide reproductive health services for teenagers, their insufficient training, inadequately equipped surgeries and low perceived support for reproductive health service provision.
Since factors for improving adolescent reproductive health concern not only physicians but also the health system and policy levels, complex measures should be designed to overcome these barriers. Discussion of a flexible model of gatekeeping, encompassing both co-ordination of care provided by GPs and the possibility of patients' self-referral, should be included in the political agenda. Adolescents tend to under-use rather than over-use reproductive health services and every effort should be made to facilitate the accessibility of such services.
BMC Family Practice 02/2006; 7:16. · 1.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this investigation is to determine the level of information among GP lecturers concerning regional health priorities, their representations of public health and of regional health priorities, and to describe the place they consider to be theirs within this field. The level of information on the priorities is extremely low among GPs. Their representations of public health are diverse. They claim to take part in a public health mission but this claim concerns individual rather than joint action. The legitimate vehicles of information for these professionals are primarily the continuous medical training associations and the State, ahead of the medical faculties. This raises the question of training and the involvement of GPs in public health initiatives. Research, whether action research, applied research or participation in more basic research would appear to be a good way of promoting their first steps towards joint action.
[Show abstract][Hide abstract] ABSTRACT: General practice doctors are naturally presented as being actors on the front lines of public health. The ability of general practitioners to be aware of and deal with public health questions largely depends upon their training. Perhaps one could consider the general practitioner's thesis as a preparatory analytical work within the area of their future field of practice. Do these theses serve to provide food for thought on general practice and its contribution to public health, and if not, could they? An analysis conducted within four medical schools in western France demonstrates that the work produced for general medicine identified as such only constitutes a fraction of the overall number of medical (non-university) theses (approximately 5%). Two possible explanations may be put forward. First, on the one hand, the theses highly depend on the context of the training and the work produced is a direct result of this. Second, on the other hand, the current methods of indexing notes in the university databases does not enable general medicine to be clearly seen and visibly recognised as an academic discipline. Two questions then remain: Can medical theses be considered as research? Should research in general medicine be carried out solely by general practitioners? It is vital that resources from outside the medical field be raised and mobilised for general practice research, whose themes are multi-disciplinary and not only clinical.
[Show abstract][Hide abstract] ABSTRACT: There is a need to promote research within and on general practice to strengthen the place and prestige of the discipline, in particular within the Universities. This kind of research would contribute to improving the day-to-day work of GP's and consequently, the quality of the services they provide to the patients. The process is under way in all the industrialized countries. However, contradictory forces are crossing the field. The solo practice of most GP's is a barrier to interchange, it slows down the learning process and prevents all kinds of team work, all things necessary to research work. Furthermore, qualitative methods, which are inherent to research in general practice may not be recognized by the scientific community. On the other side, there is a great temptation to reject the conventional standards and proclaim the right to differency, which might be fatal.
Cahiers de sociologie et de démographie médicales 01/2001; 41(1):47-80.