[Anticoagulant (AVK) and antibiotic drug interactions in community practice]. / Intéraction médicamenteuse anti-vitamines K/antibiotiques en médecine de ville.

AIM: Anticoagulants (AVK) are frequently responsible for iatrogenic accidents leading to hospitalisation. Antibiotics (ATB) are likely to interact with AVK. The aim of this study was to assess if Loire region practitioners complied with the French agency for the safety of health products (AFSSAPS) recommendations for AVK/ATB association. METHOD: Two strategies were implemented: a retrospective study of the 2007 Loire region general health insurance data on a population exposed to a single AVK split in two groups, exposed or not to antibiotics; a focus-group of practitioners from the Maine et Loire subdivision. RESULTS: Blood tests were not always performed. The proportion of blood tests per month was significantly more frequent in the AVK/ATB group than in the group "not exposed" to antibiotics. GPs did not implement this recommendation, which doesn't correspond to their behaviour, as analysed by a focus-group, and to the low incidence of hospitalisations due to AVK/ATB interaction. CONCLUSION: Loire region practitioners do not follow AFSSAPS recommendations. AVK/ATB interaction must be a GP's constant concern whether responsible or not for initiating AVK.

[Aborting women social characteristics: a study in Maine-et-Loire region (France) in 2007]. / Caractéristiques sociodémographiques des femmes recourant à l'interruption volontaire de grossesse, et de sa prise en charge dans le Maine-et-Loire en 2007.

The number of voluntary termination of pregnancies (VTOP) in the district of Maine-et-Loire (France) has been slightly increasing in the last ten years but the rate of childbearing age seems to be stable as it is on a national or regional data. The aborting women in this district seem to be representative of French women terminating pregnancy regarding sociodemographical, gynaecological and contraception criteria. When they come to abort, the terms of the pregnant women are also representative. But if we compare the three family planning clinics of this department, we realise that the psycho-social interview is not equally carried out. In these three centres, there is the same proportion of medication abortion (as on a national and regional scale) but much less surgical abortion under general anaesthetic in Cholet (3.9%) than in Angers (27.7%) or Saumur (64.2%). The regional rate was of 30% and the national one of 65%. The explanation is the lack of time slot for general anaesthetics in Cholet and Angers. The majority of these women used a contraception method to avoid unwanted pregnancies but we observe a lot of failures due to natural methods and condoms (especially with young people). School prevention as well as prevention on a larger population of women and couples must be comprehensive and carried out seriously. It is essential to train doctors sufficiently and regularly on the questions of contraception in general (methods, instructions…).

[General practitioners' (GPs) practice regarding the line to take in case of missed pill]. / Le médecin généraliste et l'oubli de pilule.

OBJECTIVE: To explore general practitioners' (GPs) practice face of missed pill and prevention of such missings. MATERIAL AND METHOD: Twenty-five GPs from Sarthe Department (Western France) took part in semistructured interview during which they expressed themselves on the prevention of missed pill and its consequences. RESULTS: Twelve out of 20 physicians stated positively that their female patients often forget their pill. However, they noted that missed pill was seldom a reason for phone call or consultation. During the initial pill prescription, GPs insisted on how to take the pill (14/25) as well as advice in case of a missed pill (22/25), their availability (12/25) and the instruction leaflet (16/25). But only five quoted the importance of involving women in the choice of contraception. On prescription renewal, only nine out of 25 ask their patients about observance defect and eight out of 25 repeated the information. If patients asked for further explanation, only two doctors out of 25 had practices in line with the French National Authority for Health's (HAS) recommandation guidelines. CONCLUSION: GPs' attitudes are partly due to a lack of practice's knowledge in primary and emergency contraception methods. It seems essential to promote GPs' training and to take into account their expectations and needs. Furthermore, female patient must be actor of the choice of her contraceptive method in order to improve compliance and, therefore, effectiveness.

[Influence of smoking among family physicians on their practice of giving minimal smoking cessation advice in 2008. A survey of 332 general practitioners in Maine-et-Loire]. / Le tabagisme des médecins généralistes a-t-il une influence sur l'abord du tabac en consultation en 2008 ? Enquête auprès de 332 médecins généralistes du Maine-et-Loire.

INTRODUCTION: Smoking among doctors would be an obstacle to effective smoking prevention, in particular the practice of minimal advice. OBJECTIVES: To assess the smoking habits of general practitioners (GPs) in the department of Maine-et-Loire and to study the link between their smoking status and their practice of minimal smoking cessation advice in 2008 in a legislative context unfavourable to smokers. METHODS: Three hundred and thirty-two GPs in the department of Maine-et-Loire answered a survey (response rate: 60%) investigating their own smoking habits and how they approach patients who smoke. RESULTS: The prevalence of active smoking among general practitioners responders was 18%, 34% were former smokers and 47% had never smoked. Regular smokers (10%) smoked on average 14 cigarettes a day and 51% were nicotine dependent (9% strongly). When consulting, 32% of doctors systematically addressed smoking habits, 20% said that they gave minimal smoking cessation advice regardless of their smoking status. Doctors who smoked were less prone to ask their patients if they smoke (p=0.002) and they believed that their smoking does not influence their practice of giving minimal smoking advice. Moreover, the incentive and coercive measures introduced in 2006 had no influence on the smoking status of physicians, but allowed them to speak more frequently about smoking to their patients. CONCLUSION: Minimal smoking cessation advice is applied systematically by only 20% of physicians regardless of their smoking status. Non-systematic smoking cessation advice benefited from the measures introduced in 2006.