[Obstacles and practical perspectives of the consultation in general medicine of migrants with psychological disorders. Qualitative study among French general practitioners]. / Obstacles et perspectives pratiques de la consultation en médecine générale du migrant porteur de troubles psychologiques. Étude qualitative auprès de médecins généralistes français.

OBJECTIVE: The aim of this study is to understand the problems of managing psychological disorders in migrant populations, based on the experience of general practitioners. METHOD: A qualitative study was carried out with general practitioners interviewed in a semi-directive mode. We chose the continuous comparison method and Peirce's pragmatic phenomenological approach to explore the lived experience. RESULTS: Thirteen interviews revealed four phenomenological categories: (1) Immigration was an experience of mental suffering from beginning to end at the source of psychological disorder migrant population (PDMPs) with the need for specialized follow-up. (2) Inadequate support on arrival, with complicated administrative procedures and insecure societal and environmental conditions, exacerbated the precariousness of migrants, making follow-up difficult. (3) Immigration was a transcultural journey in which the language, attitudes and perceptions of each individual blurred understanding of symptoms and care, and thus professional communication. (4) Unprepared general practitioners found counselling migrants to be difficult, time-consuming and complex. They pointed to the need for a coordinated system with comprehensive multidisciplinary care.Data saturation was reached. Three researchers were brought together. CONCLUSION: This study highlights the difficulties encountered by general practitioner (GPs) dealing with migrant patients in France. They feel helpless in the face of the nature of the disorders encountered and experience a disparity between the connections that are difficult to establish and those in their usual practice, even when professional experience with this population is acquired. They point to the need for coordinated models of care, financed by public policy.

OBJECTIF: L'objectif de cette étude est de comprendre les problèmes de la prise en charge des troubles psychologiques chez les personnes migrantes à partir de l'expérience des Médecins Généralistes. MÉTHODE: Une étude qualitative a été réalisée auprès de médecins généralistes interrogés sur un mode semi-directif. Nous avons choisi la méthode de comparaison continue et l'approche phénoménologique pragmatique de Peirce, afin d'explorer l'expérience vécue. RÉSULTATS: Treize entretiens réalisés ont permis de faire émerger quatre catégories phénoménologiques : (1) La migration était un itinéraire de l'expérience de la souffrance mentale du départ jusqu'à l'arrivée, à l'origine des TPPM avec nécessité d'un suivi spécialisé. (2) L'accueil insuffisant à l'arrivée du migrant, avec un parcours administratif compliqué et des conditions sociétales et environnementales insécures aggravaient leur précarité rendant leur suivi difficile. (3) La migration était un itinéraire transculturel dans lequel le langage, les attitudes et les représentations de chacun brouillaient la compréhension des symptômes et des soins et donc la communication professionnelle. (4) Les médecins généralistes impréparés considéraient la consultation du migrant inadaptée, chronophage et complexe. Ils pointaient la nécessité d'un dispositif coordonné avec une prise en charge globale pluridisciplinaire.La saturation des données a été atteinte. Il y a eu triangulation de trois chercheurs. CONCLUSION: Ce travail expose les difficultés rencontrées par les MG confrontés aux patients migrants en France. Ils se sentent démunis devant la nature des troubles exprimés et ressentent une inadéquation entre la relation difficile à mettre en place et celle de leur exercice habituel, même lorsque l'expérience professionnelle auprès de cette population est développée. Ils témoignent un besoin de modèles coordonnés de prises en charge, financés par les politiques.

General practitioners must acquire skills to communicate with child with Autism Spectrum Disorder to regain their values and role in the follow-up - phenomenological study.

OBJECTIVE: To understand the perceptions and attitudes of general practitioners (GPs) regarding children with an Autism Spectrum Disorder (ASD). DESIGN: Phenomenological qualitative study. SETTING: Three focus groups, clinical settings. SUBJECTS: French GPs. MAIN OUTCOME MEASURES: 22 GPs took part in the study divided among three focus groups. They were volunteers to participate. Data were transcribed verbatim and analysed using a grounded theory data analysis, completed with a semiopragmatic analysis. RESULTS: Representing autism as a strange disorder in the doctor-patient relationship, GPs perceive a loss of sensory contact with the child with ASD that prevents the usual professional relationship between doctor and patient. They disengage themselves from monitoring the subject, concentrating on supporting the family. According to them, their role was to refer the patient to a specialist in the case of clinical intuition, but they have several reasons to give themselves time, all the more so because once the diagnosis is made, they lose sight of the patient and their place in the care pathway. GPs expressed the need to acquire skills and strategies to communicate with the autistic child to recover their role and values. CONCLUSION: GPs are disconcerted by the idea of communicating with children with ASD, as it takes them out of their usual professional benchmarks. They need communication tools that enable them to regain their role and relational value of the patient-centred approach. Beyond this, the question of the 'ethics of care' of the patient with a joint attention disorder is raised.KEY POINTSGPs are disconcerted with the idea of communicating with children with ASD.GPs need communication tools that enable them to regain their role and relational value of the patient-centred approach.The question of the 'ethics of care' of the patient with a joint attention disorder is raised.

Meeting the needs of pregnant women in socially vulnerable situations: A phenomenological qualitative study.

Objective: Vulnerability relates to fragile physical, psychological, and socio-environmental circumstances. Pregnant women's social vulnerability can lead to disruptions in their medical follow-ups, prematurity, and increased infant mortality rates, such that their special needs must be considered. Yet, despite different governments' 'perinatality' plans, international literature suggests their care can be improved. Although quantitative studies regularly evaluate these plans, few studies have assessed vulnerable pregnant women's views. This study explores the needs and expectations of vulnerable women regarding their follow-ups during pregnancy and identified strategies to improve their circumstances. Methods: The study was a phenomenological qualitative study involving semi-structured interviews with women who gave birth in the past six months (December 2017 to June 2018) and who fulfilled at least one vulnerability criterion. The women were recruited by French midwives and general practitioners (GPs). Findings: Concerning these vulnerable pregnant women, three phenomenological categories emerged: 1) they need to be monitored by a single trusted contact; 2) they seek medical and social support adapted to their situations that addresses their needs; and 3) they expect kind and person-centred communication skills from professionals who provide them appropriate information. Conclusion: We identified various international recommendations to screen and care for vulnerable pregnant women, but still these women often experience numerous challenges. Finally, the implementation of recommendations for healthcare professionals based on women's real-life experiences could help optimise the identification of vulnerable pregnant women as well as their follow-up care.

The Primary Care and Environmental Health e-Learning Course to Integrate Environmental Health in General Practice: Before-and-After Feasibility Study.

BACKGROUND: Environmental and behavioral factors are responsible for 12.6 million deaths annually and contribute to 25% of deaths and chronic diseases worldwide. Through the One Health initiative, the World Health Organization and other international health organizations plan to improve these indicators to create healthier environments by 2030. To meet this challenge, training primary care professionals should be the priority of national policies. General practitioners (GPs) are ready to become involved but need in-depth training to gain and apply environmental health (EH) knowledge to their practice. In response, we designed the Primary Care Environment and Health (PCEH) online course in partnership with the Occitanie Regional Health Agency in France. This course was used to train GP residents from the Montpelier-Nimes Faculty of Medicine in EH knowledge. The course was organized in 2 successive parts: (1) an asynchronous e-learning modular course focusing on EH knowledge and tools and (2) 1 day of face-to-face sessions. OBJECTIVE: This study assessed the impact of the e-learning component of the PCEH course on participants' satisfaction, knowledge, and behavior changes toward EH. METHODS: This was a pilot before-and-after study. Four modules were available in the 6-hour e-learning course: introduction to EH, population-based approach (mapping tools and resources), clinical cases, and communication tools. From August to September 2021, we recruited first-year GP residents from the University of Montpellier (N=130). Participants' satisfaction, knowledge improvements for 19 EH risks, procedure to report EH risks to health authorities online, and behavior change (to consider the possible effects of the environment on their own and their patients' health) were assessed using self-reported questionnaires on a Likert scale (1-5). Paired Student t tests and the McNemar χ2 test were used to compare quantitative and qualitative variables, respectively, before and after the course. RESULTS: A total of 74 GP residents completed the e-learning and answered the pre- and posttest questionnaires. The mean satisfaction score was 4.0 (SD 0.9) out of 5. Knowledge scores of EH risks increased significantly after the e-learning course, with a mean difference of 30% (P<.001) for all items. Behavioral scores improved significantly by 18% for the participant's health and by 26% for patients' health (P<.001). These improvements did not vary significantly according to participant characteristics (eg, sex, children, place of work). CONCLUSIONS: The e-learning course improved knowledge and behavior related to EH. Further studies are needed to assess the impact of the PCEH course on clinical practice and potential benefits for patients. This course was designed to serve as a knowledge base that could be reused each year with a view toward sustainability. This course will integrate new modules and will be adapted to the evolution of EH status indicators and target population needs.

Integrating general practitioners into crisis management would accelerate the transition from victim to effective professional: Qualitative analyses of a terrorist attack and catastrophic flooding.

BACKGROUND: In 2018, Trèbes, 6,000 inhabitants with nine general practitioners (GPs) in southern France, experienced two tragedies; a terrorist attack in March, in which four people were killed, and a catastrophic flood in October, in which six people died and thousands more were affected. OBJECTIVES: We aimed to obtain a substantive theory for improving crisis management by understanding the personal and professional effects of the two successive disasters on GPs in the same village. METHODS: This qualitative study conducted complete interviews with eight GPs individually, with subsequent analyses involving the conceptualisation of categories based on grounded theory. RESULTS: The analysis revealed that GPs underwent a double status transition. First, doctors who experienced the same emotional shock as the population became victims; their usual professional relationship changed from empathy to sympathy. The helplessness they felt was amplified by the lack of demand from the state to participate in the first emergency measures; consequently, they lost their professional status. In a second phase, GPs regained their values and skills and acquired new ones, thus regaining their status as competent professionals. In this context, the participants proposed integrating a coordinated crisis management system and the systematic development of peer support. CONCLUSION: We obtained valuable information on the stages of trauma experienced by GPs, allowing a better understanding of the effects on personal/professional status. Thus, the inclusion of GPs in adaptive crisis management plans would limit the effects of traumatic dissociation while increasing their professional effectiveness.

The first pelvic examination: A rite of passage for the women. A qualitative study about French women.

Background: French general practitioners (GP) and gynaecologists can make use of recommendations when performing a patient's first pelvic examination. The indications and techniques for this examination are clear. The relational aspects and experience of the patients have been dealt with little.Objectives: To analyse and understand the experience of French women during their first pelvic examination to propose practice recommendations based on their experiences.Methods: Qualitative semi-structured interviews was conducted with 13 French women aged 18-30 years recruited from the surgery of a general practitioner using the snowball method. The data were analysed using an inductive method.Results: The first pelvic examination was considered an indispensable rite of passage into adulthood and the life of a woman. They wanted a preparation for a consultation devoted to the first pelvic examination, with a time that is adapted to each woman. A patient-centred practitioner was more important than the pelvic examination itself.Conclusion: Women requested for a general practitioner or a gynaecologist with a deeper understanding of a woman's experience to perform their first pelvic examination. We propose practical recommendations: the following 3 phases for the consultation: before the pelvic examination where the women and the practitioners may get to know one another; during the examination, which would involve the technical aspects and the associated procedures; and after the examination, where the patients and the practitioners review the experience and discuss prevention.