Pratiquer la responsabilité sociale en santé : de la théorie à la pratique. Une étude Delphi internationale.

INTRODUCTION: Health professionals’ social responsibility in health resists translation into skills that can be taught and implemented concretely in professional practice. PURPOSE OF THE RESEARCH: This study, conducted by the Réseau International Francophone pour la Responsabilité Sociale en Santé (RIFRESS), aims to develop a consensus on the components of doctors’ social responsibility in health from the perspective of experts in medical education. Its findings are intended to inform the creation of a skills profile. A three-round Delphi consensus method was used, with an open first round and closed second and third rounds. Mesydel software was used to organize the process and to do the qualitative analysis of the first round. SPSS was used for consensus analysis for rounds 2 and 3. RESULTS: Thirty-four experts responded to the study. During the first round, 62 codes emerged, grouped into 13 themes. From the initial analysis, 40 items were submitted for the Delphi round 2. Of these 40 items, 23 came out consensual after the second round, as did 13 of the 18 resubmitted items after the third. Examples of items that emerged as consensual are eco-responsibility, advocacy, defense of the common good, critical analysis of practice, and collaborative leadership. CONCLUSIONS: The present study represents a much-needed effort to concretely define the components of doctors’ social responsibility in health. Local context must be taken into account when using these findings. They can help to train tomorrow’s doctors to better meet the priority health needs of society in a profoundly changing world.

General practitioners' well-being in Belgium: results from the cross-sectional PRICOV-19 study.

BACKGROUND: The mental health and well-being of GPs is a critical issue as they play a vital role in providing healthcare services to individuals and communities. Research has shown that GPs often face high levels of stress, burnout, and mental health problems due to their demanding work environment. During the COVID-19 pandemic, GPs faced additional challenges which further impacted their mental health and well-being. This study aims to investigate the impact of systemic work-related stressors on the level of well-being of GPs in Belgium during the pandemic, with a particular emphasis on identifying regional variations between Flanders, Wallonia, and Brussels-Capital. METHODS: Data were collected with a self-reported online questionnaire from 479 GPs Belgian practices between December 2020 and August 2021 as part of the international PRICOV-19 study that explored the organization of general practices during COVID-19 in 38 countries to guarantee safe, effective, patient-centered, and equitable care. Well-being was evaluated by the Mayo Clinic's expanded 9-item well-being index. RESULTS: The findings of this study reveal notable regional discrepancies in the degree of well-being experienced by Belgian GPs, with the Walloon region displaying the lowest level of well-being (37%) in a population highly susceptible to professional distress (57%). Among the key stressors contributing to such distress, financial difficulties among patients (p < 0.011), the fee-for-service payment system (p = 0.013), a lack of work-related purpose (p = 0.047), and inadequate work-life balance (p < 0.001) were identified as significant factors. When examining the influence of regional disparities, it was found that the sole significant interaction between work-related stressors and region regarding the probability of experiencing distress was related to the possibility of workload sharing among practice personnel. CONCLUSION: The findings from this study underscore the imperative for more comprehensive research aimed at scrutinizing the differences in well-being across the three regions in Belgium and identifying the systemic factors that influence the practice environment, as opposed to exclusively concentrating on enhancing individual resilience.

Experiences of general practice residents during the COVID-19 health crisis: impact on anxiety and motivation for general practice / Vécu des internes en médecine générale lors de la crise sanitaire du COVID-19 : répercussions sur l'anxiété et la motivation pour la médecine générale

INTRODUCTION: The COVID-19 health crisis has turned the entire health care system and its actors upside down. For interns in general practice (IMGs), it has changed the way they practice medicine on a daily basis, disrupted their training, and highlighted their social responsibility, a factor that predisposes them to practice general medicine. OBJECTIVE: To assess the impact of the health crisis on the anxiety and motivation for general practice of IMGs. METHOD: Cross-sectional study using an online questionnaire (Qualtrics©) distributed by e-mail to IMGs of two French-speaking Belgian universities between 1 and 31 July 2020 following the first wave of the COVID-19 pandemic. RESULTS: In a sample of 188 IMGs, the following variables, considered as significant risk factor for anxiety, were analyzed: psychological distress prior to the lockdown (OR=2.894), having more than 15 daily telephone consultations during the lockdown (OR=2.724), worrying about being affected by COVID-19 (OR=2.892), or deterioration in quality of life (OR=3.335). Conversely, the feeling of practicing in a supportive environment (OR=0.311) is a protective factor against anxiety. Finally, the feeling of social usefulness reinforces the motivation of IMGs for their profession (OR=4.737). CONCLUSION: This study allowed us to better identify the factors of anxiety and motivation for specialization in general practice among IMGs just after the first wave of COVID-19. Awareness of the risk factors for professional distress and how to deal with them should be considered in the university curriculum.

Introduction: La crise sanitaire du COVID-19 a ébranlé l'ensemble du système de soins de santé et des acteurs qui le constitue. Pour les internes en médecine générale (IMG), celle-ci a modifié l'exercice de la pratique médicale quotidienne, perturbé leur formation et mis en exergue leur responsabilité sociale, l'un des facteurs prédisposant à exercer la médecine générale. Objectif: Évaluer l'impact de la crise sanitaire sur l'anxiété et la motivation pour la médecine générale des IMG. Méthode: Étude transversale réalisée par le biais d'un questionnaire en ligne (Qualtrics©) distribué par courrier électronique aux IMG de deux universités belges francophones, entre le 1er et le 31 juillet 2020, à la suite de la première vague de la pandémie du COVID-19. Résultats: Dans un échantillon de 188 IMG, les variables suivantes ont été analysées : la détresse psychologique préalable au confinement (OR=2,894), réaliser plus de 15 consultations téléphoniques journalières durant le confinement (OR=2,724), l'inquiétude d'être affecté par la COVID-19 (OR=2,892) ou la dégradation de la qualité de vie (OR=3,335), agissent comme des facteurs de risque significatifs de l'anxiété. A contrario, le sentiment de pratiquer dans un environnement soutenant (OR=0,311) est un facteur protecteur de l'anxiété. Enfin, le sentiment d'utilité sociale renforce la motivation des IMG pour leur métier de médecin généraliste (OR=4,737). Conclusion: Cette étude a permis de mieux identifier certains facteurs contributifs d'anxiété parmi les IMG et d'évaluer leur motivation pour la spécialisation en médecine générale après la première vague du COVID-19. Une sensibilisation aux facteurs de risque de la détresse professionnelle et aux ressources à déployer pour y faire face devrait être intégrée au programme des facultés.

Distress and Wellbeing among General Practitioners in 33 Countries during COVID-19: Results from the Cross-Sectional PRICOV-19 Study to Inform Health System Interventions.

Emerging literature is highlighting the huge toll of the COVID-19 pandemic on frontline health workers. However, prior to the crisis, the wellbeing of this group was already of concern. The aim of this paper is to describe the frequency of distress and wellbeing, measured by the expanded 9-item Mayo Clinic Wellbeing Index (eWBI), among general practitioners/family physicians during the COVID-19 pandemic and to identify levers to mitigate the risk of distress. Data were collected by means of an online self-reported questionnaire among GP practices. Statistical analysis was performed using SPSS software using Version 7 of the database, which consisted of the cleaned data of 33 countries available as of 3 November 2021. Data from 3711 respondents were included. eWBI scores ranged from -2 to 9, with a median of 3. Using a cutoff of ≥2, 64.5% of respondents were considered at risk of distress. GPs with less experience, in smaller practices, and with more vulnerable patient populations were at a higher risk of distress. Significant differences in wellbeing scores were noted between countries. Collaboration from other practices and perception of having adequate governmental support were significant protective factors for distress. It is necessary to address practice- and system-level organizational factors in order to enhance wellbeing and support primary care physicians.