L'exercice de la médecine générale à l'épreuve des crises sanitaires : de Lubrizol à la COVID.

INTRODUCTION: Following the fire of the chemical products stored by the Lubrizol (Seveso upper tier) and Normandie Logistique companies on 26 September 2019 in Rouen, a research group bringing together general practitioners (GP), anthropologists and sociologists has undertaken a multidisciplinary qualitative investigation of general practitioners. The initial objective was to study the practice of primary care health professionals following the event. Initiated in February 2020, this survey was strongly transformed by the COVID-19 pandemic. COVID-19 changed the object of this study, imposed a reflection and a link between the two crises, where GPs found themselves once again on the front line. PURPOSE OF RESEARCH: To analyze the practices of general practitioners in situations of uncertainty in the context of these extraordinary events, namely an industrial fire and a viral pandemic. METHODS: Eighteen general practitioners were interviewed between February and July 2019 in semi-structured interviews conducted by a pair of researchers (sociologist and GP). An analysis inspired by the grounded theory was carried out on three levels (individual thematic analysis, paired confrontation, and collective restitution). CONCLUSION: In the health crisis contexts studied, GPs were confronted with more recurrent complaints while they had relatively little robust knowledge on which to base their responses. Finally, physicians responded to these situations of high uncertainty by drawing in original ways on their personal experiences of these crises.

Evaluation of automatic annotation by a multi-terminological concepts extractor within a corpus of data from family medicine consultations.

INTRODUCTION: Research in family medicine is necessary to improve the quality of care. The number of publications in general medicine remains low. Databases from Electronic Medical Records can increase the number of these publications. These data must be coded to be used pertinently. The objective of this study was to assess the quality of semantic annotation by a multi-terminological concept extractor within a corpus of family medicine consultations. METHOD: Consultation data in French from 25 general practitioners were automatically annotated using 28 different terminologies. The data extracted were classified into three groups: reasons for consulting, observations and consultation results. The first evaluation led to a correction phase of the tool which led to a second evaluation. For each evaluation, the precision, recall and F-measure were quantified. Then, the inter- and intra-terminological coverage of each terminology was assessed. RESULTS: Nearly 15,000 automatic annotations were manually evaluated. The mean values for the second evaluation of precision, recall and F-measure were 0.85, 0.83 and 0.84 respectively. The most common terminologies used were SNOMED CT, SNOMED 3.5 and NClt. The terminologies with the best intra-terminological coverage were ICPC-2, DRC and CISMeF Meta-Terms. CONCLUSION: A multi-terminological concepts extractor can be used for the automatic annotation of consultation data in family medicine. Integrating such a tool into general practitioners' business software would be a solution to the lack of routine coding. Developing the use of a single terminology specific to family medicine could improve coding, facilitate semantic interoperability and the communication of relevant information.