How do general practitioners put preventive care recommendations into practice? A cross-sectional study in Switzerland and France

Paul Sebo (1) , Bernard Cerutti (2) , Jean-Pascal Fournier (3) , Cédric Rat (4, 3) , Fabien Rougerie (5) , Nicolas Senn (6) , Dagmar Haller (1, 6, 7) , Hubert Maisonneuve (8)

1 Faculty of Medicine - Primary Care Unit [Geneva, Switzerland]
2 UNIGE - Université de Genève = University of Geneva
3 DMG Nantes - Département de médecine générale [Université de Nantes - UFR de Médecine et des Techniques Médicales]
4 CRCINA - Centre de Recherche en Cancérologie et Immunologie Nantes-Angers
5 UNISTRA - Université de Strasbourg
6 UNIL - Université de Lausanne = University of Lausanne
7 Geneva University Hospitals and Geneva University
8 Faculté de Médecine - Département de Médecine Générale [UNIV Strasbourg]

Objectives We previously identified that general practitioners (GPs) in French-speaking regions of Europe had a variable uptake of common preventive recommendations. In this study, we describe GPs’ reports of how they put different preventive recommendations into practice. Design, setting and participants Cross-sectional study conducted in 2015 in Switzerland and France. 3400 randomly selected GPs were asked to complete a postal (n=1100) or online (n=2300) questionnaire. GPs who exclusively practiced complementary and alternative medicine were not eligible for the study. 764 GPs (response rate: postal 47%, online 11%) returned the questionnaire (428 in Switzerland and 336 in France). Main outcome measures We investigated how the GPs performed five preventive practices (screening for dyslipidaemia, colorectal and prostate cancer, identification of hazardous alcohol consumption and brief intervention), examining which age group they selected, the screening frequency, the test they used, whether they favoured shared decision for prostate cancer screening and their definition of hazardous alcohol use. Results A large variability was observed in the way in which GPs provide these practices. 41% reported screening yearly for cholesterol, starting and stopping at variable ages. 82% did not use any test to identify hazardous drinking. The most common responses for defining hazardous drinking were, for men, ≥21 drinks/week (24%) and ≥4 drinks/occasion for binge drinking (20%), and for women, ≥14 drinks/week (28%) and ≥3 drinks/occasion (21%). Screening for colorectal cancer, mainly with colonoscopy in Switzerland (86%) and stool-based tests in France (93%), was provided every 10 years in Switzerland (65%) and 2 years in France (91%) to patients between 50 years (87%) and 75 years (67%). Prostate cancer screening, usually with shared decision (82%), was provided yearly (62%) to patients between 50 years (74%) and 75–80 years (32%–34%). Conclusions The large diversity in the way these practices are provided needs to be addressed, as it could be related to some misunderstandingof the current guidelines, to barriers for guideline uptake or, more likely, to the absence of agreement between the various recommendations.

Mots clés: diversity; prevention; primary care; screening.

Domaines: Sciences du Vivant [q-bio]; Médecine humaine et pathologie

Paul Sebo, Bernard Cerutti, Jean-Pascal Fournier, Cédric Rat, Fabien Rougerie, et al.. How do general practitioners put preventive care recommendations into practice? A cross-sectional study in Switzerland and France. BMJ Open, 2017, 7 (10), pp.e017958. ⟨10.1136/bmjopen-2017-017958⟩. ⟨hal-03525775⟩