[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: 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