[Impact of a program encouraging prevention in primary care on a daily and opportunistic basis]. / Impact d'un programme encourageant la prévention en soins primaires au quotidien et de façon opportuniste.

In France, clinical preventive practices are still underdeveloped and formalized, notably due to a lack of guidelines, despite the fact that a proactive and systematic prevention and health promotion strategy involving all healthcare professionals seems essential. The P3C program aims to encourage preventive clinical practices among healthcare professionals, and thus contribute to the emergence of a common culture of prevention.

[IPA in primary care: a new gateway to the healthcare system]. / L'IPA en soins primaires : une nouvelle porte d'entrée dans le système de santé.

In France, the supply of healthcare services remains insufficient to meet the growing needs of the population, which has prompted the legislator to authorize direct access to certain professionals, in particular advanced practice nurses (APNs) working in coordinated practice structures. This article details an innovative multi-professional pathway in a nursing home, where the APN takes direct charge of people without a general practitioner, with the aim of improving their access to care and reintegrating them into the healthcare system.

[Misuse of paracetamol in primary care: Cross-sectional study in a French rural context]. / Mésusage du paracétamol en soins primaires : étude transversale dans un contexte rural français.

OBJECTIVE: To estimate the prevalence of the paracetamol use for a reason other than pain (qualitative misuse) during the last 12 months in patients consulting their general practitioner, as well as the reasons for this misuse. METHODS: Descriptive cross-sectional analysis, with gender weighting to estimate the prevalence of paracetamol misuse. RESULTS: In total, data from 209 patients were included in the analysis. Among them, 11 patients declared having taken paracetamol for a reason other than pain, i.e., a gender-weighted prevalence of 5.7% (95% CI: 3.0 to 10.4). Nearly two-thirds of these patients said they had done it to feel better. CONCLUSIONS: The paracetamol misuse is rare but real in general practice. Further studies are needed to better understand it, especially qualitative studies.

[The place of sexual health in general medicine]. / Place de la santé sexuelle en médecine générale.

OBJECTIVE: Assessment of the practices and knowledge of general practitioners in Bouches-du-Rhône and Vaucluse regarding their patients's sexual health. METHOD: A descriptive cross-sectional study was conducted among general practitioners in Bouches-du-Rhône and Vaucluse from January 12, 2023 to February 9, 2023. A questionnaire was developed and sent to general practitioners practicing in Bouches-du-Rhône and Vaucluse. It was distributed by personal and professional emails and numbers, and Bouches-du-Rhône and Vaucluse's medical order. The questionnaire was divided into three parts: the first collected demographic and epidemiological data, the second assessed knowledge and practices of general practitioners regarding the sexual health, and the last evaluated practitioner's obstacles to talking about sexual health. RESULTS: Ninety-nine general practitioners responded to the questionnaire (99/276, 35.9%). In all, 30.3% obtained a rate of correct answers>60%. The general practitioners with the best response rates had training in sexology or a degree in gynecology (P=0.0109). In their practices, some topics such as contraception for adolescents, the reassessment of contraception, the search for vulvuvaginal disorders in postmenopausal patients are more addressed by doctors and in particular those of the female sex. Other topics such as sexual violence, male sexual dysfunction and sexual health in patients over 70 are less discussed in consultation. CONCLUSION: The care of sexual health is an important part of global health, specific to the profession of general practitioner. The results of our study suggest that the knowledge and practices of general practitioners in Bouches-du-Rhône and Vaucluse, are perfectible. The establishment of professional training, consultation dedicated to prevention, or even better awareness of sexual health professionals would promote a better screening.

Primary Care Physicians' and Hospitalists' Experience with Advance Care Planning with South Asian Canadian Older Adults before and during COVID-19.

Few older adults discuss their end-of-life care wishes with their physician, and even fewer minorities do this. We explored physicians' experience with advance care planning (ACP) including the barriers/facilitating factors encountered when initiating/conducting ACP discussions with South Asians (SA), one of Canada's largest minorities. Eleven primary care physicians (PC) and 11 hospitalists with ≥ 15 per cent SA patients ≥ 55 years of age were interviewed: 10 in 2020, 12 in 2021. Thematic analysis of transcripts indicated that cultural and communication barriers, physician's specialization, SA older adults' lack of ACP awareness, and decision-making deference to family and physicians were barriers to ACP discussions. Although the COVID-19 pandemic impacted physicians' practices, contrary to our hypothesis most reported no change in frequency of ACP discussions. Although ACP discussions were viewed as best conducted by PC physicians, only 55 per cent had ACP training and only 64 per cent had used ACP tools. Training in ACP facilitation, concerning ACP tool usage, and training in patient-physician communication are recommended.

Community-Based Nutrition Risk Screening in Older Adults (COMRISK): An Exploration of the Experience of Being Screened and Prevalence of Nutrition Risk in Alberta, Canada.

The objectives of this feasibility study were to measure the prevalence of nutrition risk in community-dwelling older adults (CDOA, ages ≥ 65 years) and explore the perspectives of CDOA of the acceptability, value, and effectiveness of nutrition risk screening in primary care and community settings. Using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN)© eight-item tool (n = 276), results indicated that moderate and high nutrition risks affected 50 per cent and 8 per cent, respectively, of those screened. Interviewees (n = 16) agreed that screening is acceptable, important, and valuable (Theme One). Effectiveness was unclear, as only 3 of 16 respondents recalled being told their nutrition risk status. When articulating nutrition-related issues, a food security theme, expressed in the third person, was prominent (Theme Two). Screening for nutrition risk and receiving nutrition information in community-based settings are acceptable to CDOA and medically necessary, as evidenced by the high proportion of CDOA at moderate-high nutrition risk.

COMmunity-Based Nutrition RISK Screening in Older Adults Living Independently (COMRISK): Feasibility, Acceptability, and Appropriateness of Community Partnership Models in Alberta, Canada.

This feasibility study of routine nutrition risk screening in community-dwelling older adults using a partnership between health care and community-based organizations (CBO) aimed to (1) evaluate the ability of community-based partnerships to provide screening for nutrition risk, and appropriately refer at-risk individuals for follow-up care and (2) determine the barriers to and facilitators of screening. Adults 65 years of age and older were screened by staff in two primary care and one CBO setting using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN)-8 nutrition risk screening tool. Screeners, organization administrators, and registered dietitians responded to surveys regarding SCREEN-8 administration, referral processes, and partnership interactions. All found the SCREEN-8 initiative feasible, acceptable, and appropriate. Sustainability requires strengthening of community resources, referral processes, and telephone assessments. The partnership added value despite limitations in communications. We conclude that broader implementation of this program using community-based partnerships has the potential to aid in the prevention of malnutrition in older adults.

A "Patient Preference" Model of Recruitment for Research from Primary-Care-Based Memory Clinics: A Promising New Approach.

Recruiting persons with dementia for clinical trials can be challenging. Building on a guide initially developed to assist primary-care-based memory clinics in their efforts to support research, a key stakeholder working group meeting was held to develop a standardized research recruitment process, with input from patients, care partners, researchers, and clinicians. Discussions in this half-day facilitated meeting focused on the wishes and needs of patients and care partners, policy and procedures for researchers, information provided to patients, and considerations for memory clinics. Patients and care partners valued the opportunity to contribute to science and provided important insights on how to best facilitate recruitment. Discussions regarding proposed processes and procedures for research recruitment highlighted the need for a new, patient-driven approach. Accordingly, a key stakeholder co-designed "Memory Clinic Research Match" program was developed that has the potential to overcome existing barriers and to increase recruitment for dementia-related research.

[Evaluation of a referral protocol to primary health care for patients eligible for health service access points following hospitalization]. / Évaluation d'un protocole d'orientation vers le droit commun parmi des patients ayant été suivis en permanence d'accès aux soins de santé suite à une hospitalisation.

INTRODUCTION: PASS is a hospital care unit that provides access to health care for precarious persons and supports them as soon as they have obtained primary health care insurance. No details of this support had previously been described. A Hospital-to-Community protocol for referral to the public health system has been developed at the adult PASS unit of the Marseille public hospitals (AP-HM). The objectives of this study are to describe how this protocol is applied, to evaluate at six months the inclusion in general practice of patients having benefited (or not) from this protocol and to determine the key influencing factors. MATERIAL AND METHOD: This two-arm prospective observational study collected data on the primary care pathways of precarious patients six months after their having obtained health coverage, and found out whether or not the newly existing protocol had been effectively implemented. It was carried out on a cohort of people included in the PASS-MULTI study who had acquired complete health coverage. RESULTS: Sixty patients were included between November 2020 and August 2022, 35 of whom had availed themselves of the Hospital-to-Community protocol. Among them, 68.8% in the interventional group had consulted their referring general practitioner within six months, vs. 40% in the control group (p = 0.04). The initiation of follow-up in general medicine was associated with application of the protocol (p = 0.04). CONCLUSION: This study described an initial Hospital-to-Community protocol for referral to the primary healthcare system of patients followed up in the PASS unit and found an association between application of this protocol and initiation of follow-up in primary healthcare.

The Evidence for Screening Older Adults for Nutrition Risk in Primary Care: An Umbrella Review.

It is not known if nutrition risk screening of older adults should be a standard practice in primary care. The evidence in support of nutrition risk screening of older adults in primary care was examined and critically analyzed using an umbrella review. The peer reviewed and grey literature were searched for clinical practice guidelines (CPGs) and systematic reviews (SRs). Titles and abstracts were independently screened by the two authors. Resources were excluded if they did not apply to older adults, did not discuss nutrition/malnutrition risk screening, or were in settings other than primary care. Full texts were independently screened by both authors, resulting in the identification of six CPGs and three SRs that met the review criteria. Guidelines were appraised with the AGREE II tool and SRs with the AMSTAR 2 tool. The quality of the CPGs was high, while the quality of the SRs was low. The CPGs and SRs acknowledged a lack of high-quality research on the benefits of regular nutrition risk screening for older adults in primary care; however, CPGs recommended annual screening for older adults in primary care practices or other community settings. High-quality research investigating nutrition risk screening of older adults in primary care is needed.

[Opportunity to develop pharmaceutical care for female infertility in community pharmacy: Results from a survey on patients' perceptions and expectations]. / Développement des soins pharmaceutiques de l'infertilité féminine à l'officine : enquête sur la perception et les attentes des patientes.

Infertility is defined as not being able to get pregnant after one year or longer of unprotected sex. The infertility rate is increasing in France and pharmaceutical care should adapt to this issue. The objective of this study was to assess how women undergoing assisted reproductive technology (ART) perceived ART-related pharmaceutical care in community pharmacies and to suggest ways of improving the service. METHOD: We conducted a study with patients undergoing ART at the Institute of Reproductive Medicine in Marseille, using a questionnaire. The questions concerned the perception of care given at the community pharmacy on various aspects related to medication, on a scale of 1 (not at all satisfied) to 10 (very satisfied). The last question was an open-ended question about patient's expectations. RESULTS: In all, 105 patients answered the questionnaire. The average age of women was 34.5±4.8-years-old. The scores obtained concerning the perception of support on the themes explored varied between 2.8±2.8 for the lowest score and 4.2±3.4 out of 10 for the highest. In all, 79.6% of the respondents were in favor of the development of specific support in community pharmacies, especially about administration methods, management of adverse effects and management of waste linked to treatment. CONCLUSION: Women undergoing ART are willing to receive pharmaceutical care in community pharmacies. In order to meet their expectations, it is necessary to develop dedicated training programs.

[First- and second-line hospital management of ophthalmologic emergencies: Clinical pathway study of 1360 patients]. / Prise en charge des urgences ophtalmologiques en premier et second recours hospitaliers : analyse du parcours de 1360 patients.

The general practitioner (GP) might offer a good alternative for the management of certain ophthalmologic emergencies in his or her practice, given the increasing demand for ophthalmological care and difficulties with access to ophthalmologists. The main objective of the study was to describe ophthalmological complaints and their management in general emergency departments compared to ophthalmological emergency departments in order to assess which pathologies can be treated by the GP. This was a single-center retrospective study at the University Hospital of Reims, based on consultation data from the general and ophthalmological emergency departments for all adult patients presenting for an ophthalmological problem in September 2019 and September 2020. Consultations where patients were brought back following a first emergency consultation and consultations for another non-ophthalmological reason were excluded. Out of 1360 consultations recorded, 16% of patients had initially consulted their GP. The 4 most frequent diagnoses were: "ocular trauma," "conjunctivitis," "eye pain" and "visual impairment." A prescription for medication was issued in 77% of cases, 37% of which were for antibiotics. Only 29% of consultations carried out in general emergency departments led to a request for a complementary ophthalmology consultation. The GP might therefore be able to manage certain ophthalmological emergencies in his or her practice as a first line and refer certain ophthalmologic emergencies. However, the training of GPs in this specialty must be reinforced in collaboration with ophthalmologists.

Factors Associated With Initiation of Antidepressant Medication in Adults With Type 1 and Type 2 Diabetes: A Primary Care Retrospective Cohort Study in Ontario, Canada.

OBJECTIVES: Depression in patients with diabetes mellitus is common and associated with poorer outcomes. This study aims to identify demographic, socioeconomic and medical factors associated with the initiation of antidepressant medication after a diagnosis of diabetes in adult patients without a previous prescription for antidepressants. We also examined frequency of primary care visits in the year after antidepressant initiation compared with the year before treatment began. METHODS: This was a retrospective cohort study using routinely collected electronic medical record data spanning January 2011 to December 2019 from the University of Toronto Practice-based Research Network (UTOPIAN) Data Safe Haven. Our primary outcome was a first prescription for an antidepressant in patients with diabetes. We used a mixed-effects logistic regression model to identify sociodemographic and medical factors associated with this event. RESULTS: Among 22,750 patients with diabetes mellitus, 3,055 patients (13.4%) began taking an antidepressant medication. Increased odds of antidepressant initiation were observed in younger patients (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.39 to 2.26), females (OR, 1.60; 95% CI, 1.46 to 1.7), those receiving insulin treatment (OR, 1.59; 95% CI, 1.43 to 1.78) and cases of polypharmacy (OR, 3.67; 95% CI, 3.29 to 4.11). There was an increase in the mean number of primary care visits from 4.6 to 5.9 per year after antidepressant initiation. CONCLUSIONS: In patients with diabetes, age, sex and medical characteristics were associated with the initiation of antidepressants. These patients accessed primary care more frequently. Screening and prevention of depression, particularly in these subgroups, could reduce its personal and systemic burdens.

Patterns and Patients' Characteristics Associated With Use of Sodium-Glucose Cotransporter-2 Inhibitors Among Adults With Type 2 Diabetes: A Population-based Cohort Study.

OBJECTIVES: Our aim in this study was to describe patterns and patient-level factors associated with use of sodium-glucose cotransporter-2 inhibitors (SGLT2is) among adults with diabetes being treated in Alberta, Canada. METHODS: Using linked administrative data sets from 2014 to 2019, we defined a retrospective cohort of adults with prevalent or incident type 2 diabetes with indications for SGLT2i use and who did not have advanced kidney disease (glomerular filtration rate <30 mL/min per 1.73 m2) or previous amputation. We describe medication dispensation patterns of SGLT2is over time in the overall cohort and among the subgroup with cardiovascular disease (CVD). Multivariable logistic regression was used to determine patients' characteristics associated with SGLT2i use. RESULTS: Of the 341,827 patients with diabetes (mean age, 60.7 years; 45.6% female), 107,244 (31.3%) had CVD. The proportion of patients with an SGLT2i prescription increased in a linear fashion to a maximum of 10.8% (95% confidence interval [CI], 10.7% to 10.9%) of the eligible cohort by the end of the observation period (March 2019). The proportion of filled prescriptions was similar for patients with CVD (10.4%; 95% CI, 10.1% to 10.6%) and for those without CVD (10.9%; 95% CI, 10.8% to 11.0%). Patients' characteristics associated with lower odds of filling an SGLT2i prescription included female sex, older age and lower income. CONCLUSIONS: The use of SGLT2is is increasing among patients with diabetes but remains low even in those with CVD. Policy and practice changes to increase prescribing, especially in older adults, may help to reduce morbidity and mortality related to cardiovascular and renal complications.

[The possible contribution of community pharmacist upstream of drug prescription in France: An experiment of practice groups between general practitioners and community pharmacists]. / La possible contribution du pharmacien d'officine en amont de la prescription médicamenteuse en France : une expérimentation de groupes de pratique médecins généralistes ­ pharmaciens d'officine.

OBJECTIVES: The implementation of practice groups between general practitioners and community pharmacists in several European countries (Belgium, the Netherlands, Switzerland) emphasizes the possible and relevant role of the community pharmacist upstream of drug prescription. In these groups, the pharmacist provides knowledge and faciltates pluriprofessional exchanges on prescription practices. This research assesses the potential of implementing these practice groups in France. METHODS: An experiment was set up in France at 9 sites. Its evaluation was based on the use of questionnaires and semi-structured interviews. The operational feasibility and the adherence of pharmacists to these practice groups were assessed. RESULTS: Our results emphasize that the integration of this practice into the pharmacist's activity is possible but encounters limits, particularly in terms of time investment by the meeting leader pharmacists, regardless of their professional status. The satisfaction of the participating pharmacists with this practice, as well as the previous characteristics of their activity, such as an interprofessional practice already established, are positive factors for the adherence of these professionals to this practice. CONCLUSIONS: If these practice groups can represent a potential new activity for the community pharmacist, several conditions could facilitate their implementation: the possibility of animation in pairs, pharmacist-physician, in order to accentuate the interprofessional collaboration while mobilizing the skills of community pharmacists, an evolution of the initial training of community pharmacists in order to strengthen the skills required to facilitate these groups, as well as a financial or professional recognition in terms of continuing education.

[Multidisciplinary primary care management of victims of domestic violence]. / Prise en charge pluridisciplinaire en soins primaires de victimes de violences intrafamiliales.

Victims of domestic violence, who may be women, children or men, require comprehensive care. The team at the Simone-Veil multi-professional health center, located in Pontarlier (25), offers them an innovative follow-up that brings together health, mental health and social professionals, law enforcement agencies and associations involved in this issue, with the support of the Bourgogne-Franche-Comté regional health agency, thus creating a territorial network.

New Diabetes Guidelines: Impact on Eligibility for Sodium-glucose Cotransporter-2 Inhibitors and Glucagon-like Peptide-1 Receptor Agonists in Canada.

OBJECTIVES: Recent diabetes guidelines call for prescribing sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) for end-organ indications (cardiovascular disease [CVD], heart failure and chronic kidney disease) and for primary prevention of CVD in adults with multiple risk factors. Our aim was to assess the effect of new guidelines on the prevalence of SGLT2i/GLP-1RA-eligible adults, and their current rates of SGLT2i/GLP-1RA use. METHODS: Cross-sectional study of Canadian adults (age ≥18 years) with diabetes on June 30, 2020, using electronic medical record data from primary care practices in 5 provinces (Alberta, Manitoba, Newfoundland, Ontario and Québec). Indications were determined from comorbidities, lab values and cardiovascular risk factors. RESULTS: End-organ indications were present in 34.1% of adults for SGLT2i, and in 17.1% for GLP-1RA (CVD only). Rates of SGLT2i and GLP-1RA use were only 14.0% and 4.3%, respectively, in those with end-organ indications. The majority of these individuals had glycated hemoglobin ≤7.0%. The combination of end-organ and primary prevention indications increased eligibility for SGLT2i to 62.6%, and for GLP-1RA to 59.1%. CONCLUSIONS: The implications of this sizeable reclassification of adults as SGLT2i/GLP-1RA indicated on health-care budgets and cost-effectiveness requires further study. In the meantime, targeted efforts are necessary to improve SGLT2i/GLP-1RA use in those with end-organ indications that have robust evidence of cardiovascular and kidney benefit from newer agents.

Potential Overtreatment and Overtesting Among Older Adults With Type 2 Diabetes Across Canada: An Observational, Retrospective Cohort Study.

OBJECTIVE: Our aim in this study was to assess potential overtreatment and overtesting among older adults with type 2 diabetes across Canada. METHODS: An observational, population-based cohort study was conducted using data available through the Canadian Primary Care Sentinel Surveillance Network. All patients included in the study were seen by a primary care provider between 2010 and 2017, ≥65 years with type 2 diabetes and had at least one glycated hemoglobin (A1C) measurement. Potential overtreatment was defined as an index A1C of <7% and being prescribed antidiabetes medications other than metformin within 1 year of the index A1C. Testing ≥3 times/year in patients with A1C <7% was considered potential overtesting. Analyses were performed/compared within 2 cross-sectional cohorts (2012 and 2016). A subcohort analysis was performed on those with advanced age and dementia. RESULTS: An overall cohort of 41,032 patients (mean age, 76.6 years) was identified. Proportions of potential overtreatment were 7.0% (2012) and 6.9% (2016) (difference in rate in %: 0.1; 95% confidence interval [CI], -0.32 to 0.52]). Overall, 19.2% (2012) and 19.0% (2016) of patients were potentially overtested (difference in rate in %: 0.2; 95% CI, -0.45 to 0.85), whereas 2.4% (2012) and 2.3% (2016) were potentially undertested (difference in rate in %: 0.1; 95% CI, -0.15 to 0.35). Among patients with dementia and advanced age, proportions of patients potentially overtreated were 14.5% and 12.1%, and those overtested were 29.2% and 25.0% in 2012 and 2016, respectively. CONCLUSIONS: Potential overtreatment and overtesting exists among older adults with diabetes in Canadian primary care practices with minimal change over time. Higher proportions of potentially unnecessary care were observed in those with advanced age and dementia. Our study highlights an opportunity for primary care clinicians to improve testing and treatment practices considering the individual patient, context and potential for net benefit.

[From home care to coordinated primary care teams]. / Des soins au domicile aux équipes de soins primaires coordonnées.

For the past fifteen years, numerous official texts have tended to reconfigure local care, particularly the activities of private health professionals who intervene in this field. They aim to promote multi-professional and coordinated organizations, in order to better manage patient care in a territorial and global approach to health.