[Use of neurodevelopmental disorder screening tool in primary care : A multicenter observational study]. / Utilisation en soins primaires d'un outil de repérage des troubles du neurodéveloppement : étude multicentrique observationnelle.

INTRODUCTION: Neurodevelopmental disorders (NDD) affect 5 to 15% of the population. Improved management largely depends on early detection in primary care. A screening tool was developed by an expert consensus and its use has been recommended since 2019. This tool has never been evaluated to date. The aim of this study was to investigate the prevalence and factors associated with the identification of neurodevelopmental disorders in primary care in children aged 6 months to 5 years. METHOD: This work is a multicentric observational study carried out in general practice in two regions of France: Île-de-France and Auvergne-Rhône-Alpes. A multivariate analysis was performed to identify the factors associated with the presence of abnormal signs on the grid. RESULTS: Five hundred and sixty-four (564) children aged 6 months to 4 years were included. The prevalence of children identified on the grid was 3.9%. The factors associated with the neurodevelopmental disorders identified in multivariate analysis were: low socio-professional status of the mother, male gender and parental concern about the child's neurodevelopment. Factors associated with identifying a developmental trajectory gap were male gender (OR = 2.10 (1.22-3.62)) and low socio-professional status of the mother (OR = 2.23 [1.05-4.70]). CONCLUSION: This original work allowed us to carry out first-line testing of a tool for the identification of NDD in primary care and to evaluate the prevalence of identification of these disorders. A complementary cohort study will be necessary to evaluate the sensitivity and specificity of this identification tool.

[Stigmatisation of patients with mental disorders by medical interns specialising in general practice: A national survey]. / Stigmatisation des patients atteints d'un trouble mental par les internes de médecine générale : une enquête nationale.

OBJECTIVES: The objective was to assess the level of stigmatisation of psychiatric patients by medical interns specialising in general practice (GP), and to assess the influencing factors of stigmatisation. METHODS: A national survey was carried out among interns in general practice (GP) contacted through their local associations from December 10, 2019 to March 9, 2020. An online questionnaire was diffused. The validated French version of the Mental Illness Clinicians' Attitudes (MICA) was used to measure stigmatising attitudes towards psychiatry and persons with psychiatric disorder by the interns. This 16-item scale is designed to measure attitudes of health care professionals towards people with mental illness with scores ranging from 16 to 96 (the most stigmatizing). Several covariates were collected: socio-demographics, personal experiences with mental health, and mental health trainings during medical studies. All questionnaires were strictly anonymized. Comparative analyses of the MICA score by group were performed using Student's tests. RESULTS: A total of 389 interns responded. The majority of respondents were female (n=277; 71%) and the mean age was 27years [standard deviation (SD)±2.39]. The mean MICA rate was 40.64 (SD±8.09) for a neutral score of 56, reflecting low overall stigmatizing attitudes. MICA scores were significantly lower among female interns (40.11 vs. 41.95; P=0.042), those who had benefited from personal psychological or psychiatric support (38.70 vs. 41.61; P=0.001), and those who had completed a psychiatric externship (39.47 vs. 42.16; P=0.001). CONCLUSIONS: GP interns had an attitude that is generally not very stigmatizing even if its improvement should still be sought. This is particularly verified among those who have completed a psychiatric internship during their externship. This suggested association should be supported by other studies. The stakes are high for the future management of patients since stigmatisation by a physician is strongly implied in the worse healthcare management of patients with psychiatric disorders, leading them to a shorter lifespan.

[Evaluation of simulation-based training program intended to improve interprofessional communication skills of community pharmacy and general medicine students]. / Formation des étudiants en pharmacie d'officine et en médecine générale à la communication interprofessionnelle : évaluation d'un programme de simulation.

OBJECTIVES: The objective of this work is to assess the impact of a simulation session on the ability of pharmacy and medicine students in general practice to communicate in the resolution of patient-facing situations. METHODS: The evaluation of the impact of the session on the representation of the professions used a questionnaire to be completed before and after the session by the students. The evaluation of the impact of the session on the perception of communication and associated skills was based on an audio recording of the debriefings, which, after transcription and thematic analysis, was used as a preliminary analysis for the drafting of a questionnaire proposed the following year. This questionnaire focused on the issues of interprofessional communication and on the seminar process. RESULTS: During the 2018 and 2019 seminars, 518 students attended, 39% were pharmacy students (n=201) and 61% were medical students (n=317). The majority of medical students initially responded that physician-pharmacist communication was confraternal and rare. More pharmacy students felt that the quality of the physician-pharmacist relationship was poor. However, there was a marked improvement for all students on this aspect of communication after the seminar. Both groups also generally agreed that this relationship could be improved. CONCLUSIONS: The evaluation shows that an interprofessional simulation program improves the ability of pharmacy and general practice students to communicate in patient-facing situations.

[Prostatic hyperplasia: Evaluation of practices in general practice, dissemination, and impact of recommendations]. / L'hypertrophie bénigne de prostate : évaluation des pratiques en médecine générale, diffusion et impact des recommandations.

INTRODUCTION: In 2015, the French Association of Urology, by the male lower urinary tract symptoms Committee, published a practices guideline for the management of prostatic hyperplasia in general practice. Five years after the publication of these recommendation, our objective is to assess their dissemination and their impact in general practice. MATERIAL: A specially designed questionnaire was distributed online via the departmental councils of the order and to all regional unions of liberal doctors. The distribution to general practitioners was at the discretion of each organisation depending on local policies. RESULTS: Two hundred and eighty responses were collected. Fifty-five percent of the population was female. 83 % of the general practitioners did not report having knowledge of the practice guideline. 77 % of doctors stated that they had not received training or information on prostatic hyperplasia in the past 5 years. Among the notable results, 51 % of general practitioners declared performing a digital rectal examination. 44 % prescribed an endorectal ultrasound. Only 7 % of doctors were aware of the existence of minimally invasive surgical techniques. CONCLUSION: The practices guideline for the management of prostatic hyperplasia in general practice proposed in 2015 by the male lower urinary tract symptoms Committee seems to be little known by general practitioners. Dissemination of these recommendations solely through publication in Progrès en Urologie seems ill-suited to consideration by general practitioners, and it seems necessary to consider other modes of dissemination. LEVEL OF EVIDENCE: 4, grade C.

[General practitioners' knowledge on means of prescribing speech therapy]. / Connaissances des médecins généralistes sur les modalités de prescription de l'orthophonie.

INTRODUCTION: General practitioners are the first prescribers of speech therapy in France, a country in which speech therapists can practice only on medical prescription. The objective of this study was to measure general practioner's knowledge on means of prescribing speech therapy. METHOD: Cross-sectional study by self-questionnaires for general practitioners and residents in general practice in France. The test assessed five types of knowledge conducive to correct prescription of speech therapy: requirements for prescription, indications, prescription wording, ages of treatment eligibility, and reimbursement. The questionnaires were tested on an expert population, whose median score was used as a cut-off to separate doctors who knew the modalities of speech therapy prescription from those whose knowledge was insufficient. The characteristics differentiating the two groups were compared by multiple logistic regression. RESULTS: Five hundred and three general practitioners and five hundred and two residents in general medicine were included; 82.3% of the physicians having written a thesis and 86.2% of the residents had insufficient knowledge of the modalities of speech therapy prescription. Age, number of years since acquisition of a medical diploma and urban practice all had a negative impact on general practitioners' knowledge of speech therapy. CONCLUSION: French general practitioners' knowledge of speech therapy prescription seems insufficient. It is consequently necessary to improve the initial and continuing training of doctors. Collaborative work between general practitioners and speech therapists should be carried on, developed and strengthened.

[Involuntary Psychiatric Hospitalizations: From request to a call center to hospitalization]. / Admission en soins psychiatriques a la demande d'un tiers : de l'appel au SAMU a l'hospitalisation.

BACKGROUND: Involuntary psychiatric hospitalization (IPH) is a heavy and complex psychiatric exception measure. In the Seine-Saint-Denis department (low medical density), the evaluation of the patient in psychiatric decompensation is the responsibility of the out-of-hours general practitioners (GP) mandated by the call center. Their feeling is the non-achievement of the procedure once the patient arrives at the emergency room. We aimed to evaluate the outcome of patients following a request for IPH from these GP. METHODS: We conducted a retrospective study based on all requests for IPH received during 2016 at the Seine-Saint-Denis emergency medical call center. The characteristics of the call and the patient, as well as the decisions of the regulator and the GP were collected. The decision of hospitalization in the emergency room was sought for patients referred for IPH. RESULTS: Of the 7541 calls for decompensation, 539 were for an IPH. These calls occurred during non-working hours in 55 % of cases. A GP was involved in more than two-thirds of the cases and requested an IPH for 240/304 (79 %) patients. Patients were male in 56 % of cases with an average age of 40 (±16) years. IPH was confirmed for 132 (61 %) patients. This rate did not differ from the 65 % reported in the literature (Z-test, P=0.26). Voluntary hospitalization was performed for 37 (17 %) other patients. DISCUSSION: The IPH rate for patients referred by GP mandated by the call center was comparable to that following the requests of the attending physicians, validating their intervention in this critical context.

[Management of suicidal crisis in general practice: evaluation of care practices according to patient age]. / Crise suicidaire, évaluation des pratiques en médecine générale selon l'âge du patient.

Nearly 800,000 people die by suicide each year worldwide. Up to 75% of suicidal patients consulted their general practitioner in the months preceding their attempt. A study, conducted among 167 practitioners in Champagne-Ardenne in 2016-2017, aims to evaluate the practices of general practitioners in the management of suicidal crisis, particularly according to the age of the patient. It provides elements for reflection on their role in suicide prevention.

Épidémiologie descriptive du risque suicidaire dans le système médical français de médecine générale.

OBJECTIVE: Suicide prevention certainly includes a better knowledge of suicide risk in primary care. A number of international publications have shown interest in assessing this risk, but mostly through specific consultant populations: young patients, old patients, anhedonic, depressive, etc. Our study analyses suicide risk prevalence in patients consulting in general medicine for any somatic or psychiatric reason, their pathology or their age. METHOD: This cross-sectional study was conducted with adult patients (827 subjects included) who were consulting a French generalist doctor panel randomly selected. They filled a validated self-questionnaire (aRSD) assessing their suicide risk in the 15 preceding days and providing professional and personal data. RESULTS: The totally operable 757 files (483 female; 274 male) show that close to a quarter of consultants (24.3%) presents with a positive suicide risk in the 15 days preceding their consultation and 6.3%, reveal a severe risk (aRSD ≥ 7) with ideas and impulses to commit the act. When the reason to consult is psychiatric, 64.6% of these consultants have aRSD positive. One time out of two, the risk is even severe. CONCLUSIONS: This data shows how important the suicide risk prevalence is in general medicine. It confirms the main role played by primary care patricians in acting to prevent suicide risk. This data also shows the contribution represented by a self-questionnaire that would rapidly assess the suicide intent while screening, it.

[The social to the test, the test of the social. Or the art of accommodating patients' social position in preventive work in general medicine]. / Le social à l'épreuve, l'épreuve du social. Ou l'art d'accommoder la position sociale des patients dans le travail préventif en médecine générale.

AIM: This article examines the way in which private general practitioners take into account the social position of their patients in their preventive work. METHODS: After a review of the main normative constructs supposed to equip the general practitioners to grasp the social dimension of their practice, the article used two surveys on the provision of preventive care, one epidemiological (PrevQuanti) and the other sociological (PrevQuali). RESULTS: Deontology, training and recommendations make it difficult to shape the social dimensions of health that pratitioners have to deal with. The PrevQuanti survey, however, revealed that the provision of preventive care is subject to almost systematic but variable social gradients. The analysis, based on the PrevQuali interview study, makes the ways in which pratitioners mobilise the social position of their patients and whether or not they adapt to it. CONCLUSION: The positionings of general practitioners can be modelled in a typology of six postures between which some oscillate.

[The geriatric hotline improves practice, survey of general practitioners in the Saint-Etienne area]. / La hot line gériatrique, enquête auprès des médecins généralistes du bassin stéphanois.

Faced with an aging French population, the demand for unscheduled care is growing. In order to avoid referring elderly patients to emergency departments, which are unsuitable for them, the Regional Health Agencies have created telephone hot lines dedicated to geriatrics. They are exclusively accessible to general practitioners in order to obtain advice or a place in a geriatric hospital. General practitioners are rarely asked about the value of this tool in their practice.

[At-risk drinking screening by general practitioners: A survey of patients in primary care]. / Repérage de la consommation d'alcool à risque par les médecins généralistes : enquête auprès de patients en soins premiers.

BACKGROUND: The screening of patients who are at-risk drinkers, which means exceeding the thresholds defined by health authorities or associated with a specific situation (taking psychotropic drugs, having an organic pathology, driving a vehicle, drinking during pregnancy), represents a major issue in primary care. Few studies have offered perspective from the patients' standpoint. The main purpose of this study was to describe general practitioners at-risk drinking screening from their patients point of view. The secondary objective was to identify the factors associated with perception of satisfactory general practitioner knowledge about alcohol consumption. METHODS: A quantitative cross-sectional study was launched in 9 general practitioner offices over 6 months. Patients older than 18 were recruited to answer a questionnaire blinded from their general practitioner, indicating the level of their alcohol consumption and their perception regarding their general practitioner's screening methods. Descriptive, univariate and multivariate logistic regression analyses were performed. RESULTS: All in all, 445 patients were analyzed. Sixty-two at-risk drinkers were screened (13.9 %). Most of the patients declared they had not been interviewed about their alcohol consumption by their general practitioner either during initial consultations (86.1 %) or over time (83.3 %). Only 4.2 % of patients had previously initiated discussion about their consumption. Patients were not ashamed to talk about alcohol (99.2 %) and found their general practitioner to be competent on this topic (100 %). In multivariate analysis, independent factors associated with a good general practitioner knowledge about their patients' current consumption were the questions put forward by their general practitioner about alcohol consumption during their first visit (P<0.001) and during subsequent visits (P<0.001). CONCLUSION: This study showed a low general practitioner screening rate of their patients' at-risk drinking. Only a minority of patients, including at-risk drinkers, declared that their general practitioner was aware of their level of alcohol consumption. Screening could be improved by being systematized during initial consultations and regularly scheduled during subsequent visits, especially in at-risk situations.

Human papillomavirus (HPV) vaccination: What can be found on the Web? Qualitative analysis of the Doctissimo.fr forum data.

BACKGROUND: Vaccine hesitancy is a major issue in general practice. Regarding human papillomavirus, less than 20% of young French girls are vaccinated. With widespread availability of health information, the Internet seems to be a place of choice to discuss this reluctance. The main objective of this study was to explore perceptions of human papillomavirus vaccination through an analysis of the Doctissimo.fr forum data. METHODS: Using Nvivo software, a qualitative study was carried out from October 2017 to May 2018 on the Doctissimo.fr discussion forum. Online discussion threads not having any message since 2010 were excluded. All threads were analyzed by two independent evaluators. RESULTS: Faced with the doubt that emanated from the discussions and the confusion about the role of the vaccine, Internet users used multiple references in order to develop a reliable discourse. The general practitioner remained a trusted person. While the vaccine was perceived as risky, the cervical smear was approved and encouraged. Although the vaccine remained a feminine concern, males also entered this debate. Through their shared experiences, Internet users tried to influence others about whether or not to get vaccinated. CONCLUSION: Changing the sexual image of the vaccine could help to establish a collective vaccination policy. Public health policies play an essential role by working with general practitioners and by increasing visibility on the web. The usefulness of the vaccine in 2019 seems to be questioned by Internet users as shown by their major approval of cervical smears. However, these two methods remain complementary in the fight against cervical cancer.

[Frailty of the elderly and physical activity in general practice: A prospective study]. / Étude de la fragilité de la personne âgée et de l'activité physique en médecine générale : à propos d'une étude prospective.

INTRODUCTION: Frailty is a transient and reversible condition that can lead to significant morbidity and mortality and to the loss of autonomy. It is one of the key issues in public health and the prevention of addiction. Physical activity is often described as a protective factor against addiction and as a factor in limiting frailty. Our goal is to analyze the relationship between physical activity and frailty among the elderly METHODS: A cross-sectional observational study was carried out in three general practice clinics located in the French department of Eure. Patients aged 65 and over were included during a consultation with their GP. Dependent patients under the ADL scale were excluded. Level of physical activity was assessed by the Ricci and Gagnon questionnaire, which defines an active profile as a score≥18 points. Frailty was sought out by the Fried scale and the SEGA A grid. Multivariate analysis was performed to adjust frailty scores to age, gender, and level of physical activity. RESULTS: Out of the 70 patients included, 36 were active (51%) and 34 inactive (49%). They were predominantly female with 47 women (67%). Average age was 75.3years. Twelve patients were diagnosed as frail (17%) with the Fried scale and 24 (34%) with the SEGA A grid. Bivariate analysis revealed a greater frailty according to the Fried criteria in the inactive than in the active patients (mean for active patients 0.56 IC95 [0.31; 0.80], compared to 1.76 [1.21; 2.32] in the inactive patients, p<0.0001). The difference in mean was likewise significant regarding the SEGA A score (6.42 IC95 [5.34, 7.49] in the active population, as opposed to 8.65 IC95 [7.15, 10.15] among the inactive, p=0.017). In multivariate analysis, the Fried scale was primarily influenced by age and ADL, while the SEGA score was impacted by female gender and level of physical activity. CONCLUSION: Physical activity seems to have a positive effect on frailty. It would be interesting to propose systematic screening for frailty in general medicine and to institute preventive measures, including physical activity. Initiatives encouraging and promoting seniors' physical activity should be strengthened.

[Management of child and adolescent depression in primary care: A systematic meta-review]. / Prise en charge de la dépression de l'enfant et l'adolescent en soins premiers : une métarevue systématique de la littérature.

OBJECTIVE: To develop a practical guide for the management of child and adolescent depression for general practitioners (GPs), suited to their practice frame, that can be implemented on a website aimed to help GPs to manage the main mental disorders encountered in primary care. METHOD: A systematic meta-review was performed as recommended by the PRISMA statement. Each step, articles' selection, inclusion, methodological assessment and data extraction for the narrative synthesis was independently performed by two researchers. A study protocol was registered on PROSPERO (number CRD42016042710). The databases Pubmed, Cochrane and Web of Science were explored. Each step was performed independently by two researchers following PRISMA. Meta-analyses and systematic reviews (including guidelines based on a systematic review), published between 2002 and 2015, in English or French, dealing with the therapeutic management, in primary care, of patients aged 6 to 18 years old with a major depressive disorder (MDD) were included. Grey literature was explored searching the websites of national and international health agencies, learned societies, and article references. The methodological and report qualities were assessed using the AGREE II, PRISMA checklist and R-AMSTAR grid. A narrative synthesis was performed to produce the practical guide, prioritizing data from the best evaluated articles. An expert group of GPs' and one child psychiatrist validated the guide in its final form. RESULTS: Thirty-eight studies were included: 12 recommendations, 5 systematic reviews and 21 meta-analyses. The best evaluated guideline had an AGREE-II assessment of 81%, and the best evaluated meta-analysis had an assessment of 86% for R-AMSTAR and 96% for PRISMA. The average scores of the R-AMSTAR and PRISMA assessments were 65% and 72% respectively. The average score of the AGREE II grid assessment was 57%. The data were synthesized into a practical guide for the GPs' practice, corresponding to the different consultation times. MDD diagnosis should be done on the DSM or ICD basis. The Childrens' Depression Rating Scale-revised or the Revised Beck Depression Inventory are useful in primary care for MDD appraisal in children and adolescents. For mild MDD a supportive psychotherapy and surveillance for 4 to 6 weeks is preconized in primary care. In the absence of improvement, a specific and structured psychotherapy is recommended, and the patient should be addressed to a child psychiatrist. For moderate to severe MDD, the young patient should be addressed to a specialist in child psychiatry. A psychotherapy, which can be associated with fluoxetine, especially in adolescents, is indicated with a revaluation of the pharmacological treatment between 4 to 8 weeks. A weekly follow-up by the GP is recommended during the first month, especially after the initiation of an antidepressant to assess the suicidal risk. Beyond the first month, a consultation should be scheduled every two weeks. CONCLUSION: A clinical guide was created from the best evidence-based data to help GPs in the management of child and adolescent MDD. A French-language website, aimed to assist GPs in mental disease management and available during their consultation, will be created based on the compilation of this meta-review with other similar meta-reviews.

[Feasibility of assessing frailty in general medicine patients aged over 65]. / Faisabilité de l'évaluation de la fragilité chez les patients de 65 ans et plus en médecine générale.

INTRODUCTION: Frailty is a complex concept that can be assessed with multiple instruments. Its assessment has often been implemented in hospitals. However, first-line prevention of the frailty syndrome is paramount in general medicine. The aim of the study was to test the feasibility and the concordance of two instruments for assessing frailty and to test the adequacy between the level of frailty and the presence of caregivers. METHODS: We conducted a descriptive, analytical cross-sectional study in Reims during two months. Patients included were 65 and older. Second consultations were not retained. We collected the patients' the SEGA and Fried scores as well as the opinions of the doctor and the resident student on the presence of frailty and the presence or not of home-help. RESULTS: There was an excellent concurrence between the doctor's assessment and the SEGA score (Kappa=0.89) and a moderate concurrence with the Fried score (Kappa=0.46) compared to 0.95 and 0.50 respectively for the resident student's assessment. The agreement between the assessments of the resident student and the doctor was excellent (Kappa=0.95) the concurrence between frailty and the home-helpers showed that when patients displayed frailty symptoms home-helpers were absent in 69.6% of the cases, but planned in 82.6%. CONCLUSION: To conclude, in general medicine, there is no reference score for fraily assessment, whereas the SEGA score is easy to use and reproducible. It can be used as a score of reference for patient assessment and monitoring.

[Prostate MRI and screening: Practice survey with general practitioner of the "Bourgogne-Franche Comté" region]. / IRM de prostate et dépistage : enquête de la pratique auprès des médecins généralistes de Bourgogne-Franche-Comté.

PURPOSE: The goal of our study was to describe general practitioner's (GP) practice regarding prostate cancer screening, the prescribing of prostate MRI and to investigate the factors associated with the prescribing of prostate MRI (pMRI). METHODS: A survey was addressed to 1127 GP of the "Bourgogne-Franche Comté" region before the new CCAFU's guidelines publication. RESULTS: 93 practitioners responded, giving a response rate of 8.3%. Eighty GP (86%) responded performing prostate cancer screening. The main means used were the assaying of PSA alone (23 practitioners, 28.8%) or the combination of PSA dosage and digital rectal examination (36 practitioners: 45%). It should be noted that 31 practitioners (39%) did not perform digital rectal examination as part of prostate cancer screening. Thirty two physicians prescribed pMRIs (34.5%.) before any urological consultation. The main indications were several abnormal PSA assays (27 GP, 84.4%) and/or suspicious rectal examination (15 GP, 46.9%). The main reason of this prescription was the gain of time for patient or urologist. Screening was carried out independently of the demographic characteristics of the physicians interviewed. Similarly, the prescription of prostate MRI was not related to the achievement of prostate cancer screening or the screening methods used. CONCLUSION: It seems that the prescription of pMRI has already become part of the prescribing habits of a number of general practitioners. LEVEL OF EVIDENCE: 4.

[General medical practice and medicinal voluntary termination of pregnancy in Grand Est, France]. / Médecine générale de ville et interruption volontaire de grossesse médicamenteuse en région Grand Est, France.

BACKGROUND: Access to VTOP (Voluntary Termination of Pregnancy) is a national priority in France. Once legalized in 1975, several laws contributed to improve access to VTOP, such as the 2004 family planning law which enabled urban practitioners to carry out orthogenic work. This law was supplemented by the 2016 health care modernization act. On the whole, the organization for VTOP access in the Grand Est region, complies with legislation and recommendations. However, private practitioners contribute little to this activity. Since there are very few gynecologists in certain areas (whether private or hospital practitioners), general practitioners seem to be the first line actors. This study aims at describing the orthogenic work of urban, government-regulated general practitioners, in the Grand Est region of France. MATERIAL AND METHOD: Data were collected from semi-directive interviews with the set of the government-regulated general practitioners doing family planning work in the Grand Est region. RESULTS: Out of the fifteen doctors who were interviewed, twelve actually suggested family planning work to their patients, and out of those twelve, seven practiced it in reality. What comes out is that the main motivation of professionals was to improve access to VTOP. Besides, they also mentioned the importance of being able to answer a real demand from their patients as well as an interest in gynecology. Hence the professionals' practice both benefits from services provided to their patients and from a diversification of their work, even though they regret that the value of this time-consuming procedure is not recognized. This study also brings out that although these medical acts were individualized and allowed better confidentiality for the patient, the risk for complications and home birth remained an obstacle. Finally, it emerges that the whole set of recommendations was not always implemented. DISCUSSION: Urban family planning, performed by general practitioners, seems to be a major line to focus on for better timeliness and quality of care. However, some obstacles have been identified such as its specificity, its time-consuming aspect, its lack of status, as well as the difficulty to comply with recommendations. CONCLUSION: The development of this practice is necessary to maintain an appropriate response to VTOP but actions to remove certain obstacles have to be carried out.

[Primary care: A definition of the field to develop research]. / Les soins primaires : une définition du champ pour développer la recherche.

BACKGROUND: Research in the field of primary care has dramatically increased in France in recent years, especially since 2013 with the introduction of primary care as a thematic priority for research proposals launched by the Ministry of Health (Direction générale de l'offre de soins). MATERIAL AND METHODS: The RECaP (Research in Clinical Epidemiology and Public Health) network is a French research network supported by Inserm, which recently implemented a specific working group focusing on research in primary care, based on a multidisciplinary approach. Researchers from different specialties participate in this group. The first aim of the group was to reach a common definition of the perimeter and of the panel of healthcare professionals and structures potentially involved in the field of primary care. For this purpose, a selection of different data sets of sources defining primary care was analyzed by the group, each participant collecting a set of sources, from which a synthesis was made and discussed. RESULTS: A definition of primary care at different levels (international, European and French) was summarized. A special attention was given to the French context in order to adapt the perimeter to the characteristics of the French healthcare system, notably by illustrating the different key elements of the definition with the inclusion of primary care actors and the type of practice premises. CONCLUSION: In conclusion, this work illustrates the diversity of primary care in France and the potential offered for research purposes.

[State of addiction care by general practitioners in north Paris]. / État de la prise en charge addictologique par les généralistes dans le nord de Paris.

BACKGROUND: General practitioners (GPs) are fully concerned with the care of patients suffering from addiction and must have the support of a specialized network. The aim of the study was to evaluate the prevalence of the addict follow-up care by GPs, their use of addictological care facilities and their needs in communicating with specialists. METHODS: Private and salaried GPs working in the 9th, 10th, 18th and 19th districts of Paris were contacted by phone, and a questionnaire was sent to those who agreed to respond. RESULTS: One hundred and thirty-eight GPs responded (median age 57 years, 38.4% women, 54% in private practice). In total, 78.9% received at least one patient weekly for alcohol dependence, 38.1% received at least one patient monthly for opiates and 40.2% for cannabis. They managed ambulatory alcohol (46.8%) and tobacco (65.0%) withdrawal schemes. Among GPs, 86.1% worked with the support of an addictological care facility structure, 69.6% reported lack of specialists for at least one product and 75.4% for at least one specific situation. CONCLUSION: The majority of GPs in north Paris providing care for patients with substance use disorder, worked with addictological care facilities structures. However, they noticed a lack of specialists with whom to communicate. Optimizations are proposed to facilitate interaction.

[Satisfaction of a pharmacovigilance declaration support network in general practice]. / Satisfaction des médecins généralistes d'un réseau d'aide à la déclaration de pharmacovigilance PharmacoMIP-MG.

OBJECTIVE: General practitioners (GPs) report little adverse drug reactions (ADR), although it is mandatory in France. The objective was to evaluate the satisfaction of the GPs who participated to a pharmacovigilance ADR declaration support network via a clinical research assistant (CRA) moving to their GP office in the French South-West region of Midi-Pyrénées. STUDY DESIGN: A satisfaction questionnaire was sent to the 59 active GPs of this network in November 2016. RESULTS: A total number of 44 GPs responded to the survey (mean age 44±11years; 48% of women). The overall satisfaction grade was rated 9/10 (SD±1). The personalized help from a CRA was highly appreciated (n=39; 89%), reduced time-loss (n=35; 90%), and facilitated communication with the local pharmacovigilance department (n=33; 85%). Most GP (95%; n=35) stated that they would keep reporting ADRs, 83% (n=35) stated to declare ADRs via the CRA, the others stated to declare ADRs directly to the Regional Pharmacovigilance Center, mainly via numerical or online tools. For 59% (n=26) their participation to the network had a positive impact on their relationship with patients through the improvement of their vigilance to ADR. DISCUSSION: Most of the active GP answered. They were very satisfied of the pharmacovigilance CRA network helping ADR reports. It may corroborate the increase of ADRs reporting in Midi-Pyrénées since this network was set up.