Nonpharmacological home remedies for upper respiratory tract infections: a cross-sectional study of primary care patients in Switzerland and France.

BACKGROUND: Many patients might be tempted to use nonpharmacological home remedies (NPHRs) to relieve upper respiratory tract infection (URTI) symptoms. However, primary care physicians (PCPs) rarely recommend NPHRs due to a lack of knowledge in this field. We conducted a questionnaire-based survey among primary care patients in Switzerland and France to explore which NPHRs they use and consider effective for 3 common URTI symptoms: sore throat/cough/common cold. METHODS: Using official physician registries, we randomly selected 50 PCPs in Geneva (Switzerland) and Lyon/Grenoble (France). Seven research assistants were involved in the recruitment of consecutive patients from the waiting rooms of these PCPs (20-25 patients per practice). Patients were asked to complete a paper-based questionnaire to assess the use and perceived effectiveness of 72 NPHRs for URTI symptoms. The list of NPHRs was developed by our research team with the help of 97 patients. Remedies were considered effective if patients reported that they were effective/very effective. Data were analysed descriptively. RESULTS: Of the 1,198 eligible patients, 1,012 agreed to participate (84.5%). The 4 most frequently used NPHRs were honey/lemon/thyme/herbal teas. Most patients using these NPHRs considered them as effective (between 77% of patients for onion syrup for cough and 94% of patients for thyme inhalations for common colds). CONCLUSIONS: Many patients reported using honey/lemon/thyme/herbal teas for URTI symptoms, and generally considered these treatments to be effective. Future research should explore the extent to which these remedies can be safely proposed as alternatives for the symptomatic treatment of ear/nose/throat complaints in primary care.

Use and perceived effectiveness of non-pharmacological home remedies for digestive symptoms: a questionnaire-based survey among primary care patients.

BACKGROUND: Patients frequently visit their primary care physician (PCP) for digestive symptoms. We aimed to compile a list of non-pharmacological home remedies (NPHRs) that patients frequently use and find effective so that PCPs can then propose them to their patients with various digestive symptoms. METHODS: In this questionnaire-based survey on the use and perceived effectiveness of NPHRs for digestive symptoms, 50 randomly selected Swiss or French PCPs consecutively recruited 20-25 patients between March 2020 and July 2021. These patients were given a list of 53 NPHRs previously developed by our research team. They were asked whether they used them (Y/N) and whether they considered them to be ineffective, not very effective, moderately effective, or very effective in treating abdominal pain (14 NPHRs), bloating (2), constipation (5), diarrhoea (10), digestion trouble (12), nausea/vomiting (2) and stomach pain (8). We considered NPHRs to be perceived as effective if patients reported that they were moderately or very effective. RESULTS: A total of 1,012 patients agreed to participate in the study (participation rate = 84.5%, median age = 52 years, women = 61%). The two most frequently used NPHRs were rice cooking water for diarrhoea (29% of patients) and prunes for constipation (22%). The perceived effectiveness of the NPHRs ranged from 82% (fennel infusions for abdominal pain) to 95% (bicarbonate for stomach pain). CONCLUSION: Our data could be useful to PCPs interested in proposing NPHRs to their patients suffering from digestive disorders, and more generally to all PCPs interested in learning more about patients' use of NPHRs in primary care.

[Use of non-pharmacological home remedies in ENT: research informs our practices and those of our patients]. / Emploi des remèdes de grand-mère en ORL : la recherche éclaire nos pratiques et celles de nos patients.

Upper respiratory tract infections (URTIs) are a common presenting condition in family medicine. The vast majority of URTIs are treated symptomatically with pharmacological or non-pharmacological treatments. This article presents some of the results of our research projects to compile a list of non-pharmacological home remedies to relieve symptoms such as sore throat, coughs and colds. Honey, thyme or lemon are often used by patients and considered to be effective. These remedies have few side-effects, and we therefore propose to include them in the range of treatments that can be proposed in family medicine.

Les infections des voies respiratoires supérieures (IVRS) constituent un motif de consultation fréquent en médecine de famille. La grande majorité des IVRS fait l'objet d'un traitement symptomatique pharmacologique ou non pharmacologique. Cet article se base sur une partie des résultats de nos projets de recherche pour constituer une liste de remèdes de grand-mère à proposer aux patients pour soulager des symptômes tels que les maux de gorge, la toux et le rhume. Le miel, le thym ou le citron sont souvent utilisés par les patients et considérés comme étant efficaces. Ces remèdes présentent peu d'effets indésirables et nous proposons donc de les intégrer dans l'arsenal thérapeutique en médecine de famille.

Primary care patients' perspectives on the use of non-pharmacological home remedies in Geneva: a cross-sectional study.

BACKGROUND: Home remedies are anchored in patients' everyday life, but their use in Western cultures remains scarcely explored. Our objectives were to investigate primary care patients' perspectives and use of non-pharmacological home remedies in Geneva (Switzerland). METHODS: In spring 2020, we conducted a cross-sectional survey among adult primary care patients in randomly selected general practices (N = 15). Patients were recruited in the waiting rooms and asked to complete a questionnaire about their sociodemographic characteristics, their home remedy use, and their expectations and reasons for using (or not using) home remedies. We employed descriptive statistics to summarise the data and logistic regression adjusted for clustering within practices to explore associations between home remedy use and participants' sociodemographic characteristics. RESULTS: Three hundred fourteen of three hundred ninety patients agreed to participate in the study (participation rate 80.5%). Home remedies were used by 64.4% of patients. The main reasons given were for preventive purposes (55.3%), self-care (41.0%), as an alternative to conventional medicine (40.5%) and to avoid or delay a medical consultation (38.5%). One-third of patients considered that it was the GP's role to spontaneously inform them about home remedies (36.4%), another third considered that it was the GP's role to inform them, but only upon specific request (32.3%), and the last third of patients declared that it was not the GP's role to provide information about home remedies (30.3%). Patients living in an urban zone (adjusted OR 2.1; 95%CI 1.0-4.4; p 0.05) and those with a tertiary education background (adjusted OR 1.9; 95%CI 1.0-3.6; p 0.05) believed that it was their GP's role to inform them about home remedies. CONCLUSIONS: Home remedies are used by a majority of primary care patients in Geneva. For a comprehensive and safe healthcare management in the context of patient-oriented medicine, more evidence-based research on efficacy and safety of home remedies as well as their place in primary care consultation is required.

Three monthly doses of 150,000 IU of oral cholecalciferol correct vitamin D deficiency in adolescents: A pragmatic study.

OBJECTIVES: To assess the efficacy of an oral high-dose cholecalciferol regimen in correcting vitamin D deficiency (VDD) in adolescents and to explore potential predictive factors on the response to treatment. METHODS: This is a retrospective chart review conducted in the Adolescent Outpatient Clinic, Geneva University Hospitals, Switzerland. One hundred-three otherwise healthy vitamin D deficient [serum 25-hydroxyvitamin D, 25(OH)D, level <50 nmol/L] adolescents (mean age 16.6) attending the clinic between 1 January 2016 and 31 December 2018 received 150,000 IU of oral cholecalciferol every month for 3 months (cumulative dose of 450,000 IU). We measured the change in serum 25(OH)D levels pre- and post-treatment and the achievement of serum 25(OH)D level post-treatment ≥75 nmol/L. RESULTS: The mean serum 25(OH)D level increased by 320%, from 26 nmol/L at baseline to 83 nmol/L at the end of the study (P < .001). The rise was significantly higher for patients initially tested in the winter/spring (mean 65 nmol/L) compared with those initially tested in the summer/autumn (mean 48 nmol/L) (P < .003). No clear relationship was found between the response to treatment and the vitamin D status at baseline. The effect of age, gender, origin and body mass index was not statistically significant. CONCLUSIONS: The present intermittent high-dose regimen is effective in treating VDD in healthy adolescents without significant variations in response between different subgroups.

[Integrative and complementary primary care medicine: new evidence in 2020]. / Médecine complémentaire intégrative : nouveautés utiles en médecine de premier recours.

Integrative medicine proposes a coordinated approach to conventional medicine and complementary treatments. This approach is of particular interest in the field of prevention and in comprehensive primary care. This article presents some key studies published in 2020, which highlight the potential benefits of an integrative approach in primary care medicine.

La médecine intégrative permet de coordonner médecine conventionnelle et traitements complémentaires. Cette approche est particulièrement intéressante dans le domaine de la prévention et dans la prise en charge globale en médecine de premier recours. Cet article présente quelques études clés, publiées en 2020, qui mettent en lumière les bénéfices potentiels d'une approche intégrative en médecine de premier recours.

[How can we intensify research efforts in primary care? A conceptual framework]. / Comment intensifier les efforts de recherche pour une médecine de famille basée sur les preuves ? - Proposition de cadre conceptuel.

In primary care, guidelines often conflict with a holistic approach to the patient's problems. This highlights both the unmet needs for evidence necessary to primary care daily decisions and the need to develop primary care research. One of the first steps to improve primary care research is to ground research initiatives into primary care practice. We propose to shape general research procedures using a framework exploring the convergent dynamics leading to shared clinical decision. In this dynamic representation, primary care research gathers new evidence from clinical states and circumstances, patients' preferences and actions, and clinical expertise. These data can feed a loop leading to enhanced clinical expertise through the uptake of research findings into routine healthcare in clinical contexts.

La consultation de médecine de famille (MF) est caractérisée par des aspects épidémiologiques et phénoménologiques différents de ceux des autres spécialités. Malheureusement, les données provenant de recherches spécifiques à la MF font souvent défaut. Nous avons développé un cadre conceptuel permettant d'ancrer les recherches dans la pratique de la MF. Nous illustrons comment utiliser ce cadre pour 1) façonner les questions de recherche, 2) concevoir les méthodes correspondantes, 3) mener les études et 4) anticiper l'implémentation des données issues de la recherche. L'utilisation d'un tel cadre conceptuel est une aide potentielle pour répondre au défi de l'implication des médecins de famille dans la genèse des questions posées, la collecte des données et l'implémentation des preuves dans la pratique quotidienne.

Vitamin D in Adolescents: A Systematic Review and Narrative Synthesis of Available Recommendations.

PURPOSE: Practical guidelines help clinicians make their preventive and therapeutic choices and improve care management. Our purpose was to collect and synthesize available recommendations concerning vitamin D in adolescents (aged 10-19 years). METHODS: We searched PubMed, EMBASE, and Cochrane databases from inception to February 5, 2019, for guidance published by different professional associations and governments. We also searched the reference lists of identified recommendations and explored the gray literature using Web search engines. We organized documents by theme: dietary requirements, thresholds, prophylactic supplementation, and treatment of deficiency. RESULTS: A total of 32 documents were identified. Most of them targeted the general population and not specifically the age group of adolescents. There is a general agreement that adolescents should not have serum 25-hydroxyvitamin D concentrations below 25-30 nmol/L to avoid poor bone health. However, there is lack of consensus on the optimal concentration to aim for, levels varying between 25 nmol/L and 150 nmol/L. Adequate nutritional requirements of vitamin D are also subject to debate with values ranging between 200 IU/d and 1,000 IU/d. The upper tolerable intake is estimated at 4,000 IU/d by all study groups. Certain associations recommend routine vitamin D supplementation in adolescents. The recommended daily preventive doses vary between 400 IU and 4,000 IU, depending on season, skin pigmentation, sun exposure, consumption of vitamin D-fortified foods, body mass index, and coexistence of certain medical conditions. In case of deficiency, different therapeutic regimens of oral vitamin D are proposed depending on the presence of illness and/or the baseline serum 25-hydroxyvitamin D concentrations. Duration of the treatment varies between 4 weeks and 3 months. A maintenance dose is generally recommended after treatment. CONCLUSIONS: At present, there is no consensus among the different societies about vitamin D needs during adolescence. Stronger, evidence-based guidance is needed to inform clinical practice.

How do general practitioners put preventive care recommendations into practice? A cross-sectional study in Switzerland and France.

OBJECTIVES: We previously identified that general practitioners (GPs) in French-speaking regions of Europe had a variable uptake of common preventive recommendations. In this study, we describe GPs' reports of how they put different preventive recommendations into practice. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional study conducted in 2015 in Switzerland and France. 3400 randomly selected GPs were asked to complete a postal (n=1100) or online (n=2300) questionnaire. GPs who exclusively practiced complementary and alternative medicine were not eligible for the study. 764 GPs (response rate: postal 47%, online 11%) returned the questionnaire (428 in Switzerland and 336 in France). MAIN OUTCOME MEASURES: We investigated how the GPs performed five preventive practices (screening for dyslipidaemia, colorectal and prostate cancer, identification of hazardous alcohol consumption and brief intervention), examining which age group they selected, the screening frequency, the test they used, whether they favoured shared decision for prostate cancer screening and their definition of hazardous alcohol use. RESULTS: A large variability was observed in the way in which GPs provide these practices. 41% reported screening yearly for cholesterol, starting and stopping at variable ages. 82% did not use any test to identify hazardous drinking. The most common responses for defining hazardous drinking were, for men, ≥21 drinks/week (24%) and ≥4 drinks/occasion for binge drinking (20%), and for women, ≥14 drinks/week (28%) and ≥3 drinks/occasion (21%). Screening for colorectal cancer, mainly with colonoscopy in Switzerland (86%) and stool-based tests in France (93%), was provided every 10 years in Switzerland (65%) and 2 years in France (91%) to patients between 50 years (87%) and 75 years (67%). Prostate cancer screening, usually with shared decision (82%), was provided yearly (62%) to patients between 50 years (74%) and 75-80 years (32%-34%). CONCLUSIONS: The large diversity in the way these practices are provided needs to be addressed, as it could be related to some misunderstandingof the current guidelines, to barriers for guideline uptake or, more likely, to the absence of agreement between the various recommendations.

Rates, Delays, and Completeness of General Practitioners' Responses to a Postal Versus Web-Based Survey: A Randomized Trial.

BACKGROUND: Web-based surveys have become a new and popular method for collecting data, but only a few studies have directly compared postal and Web-based surveys among physicians, and none to our knowledge among general practitioners (GPs). OBJECTIVE: Our aim is to compare two modes of survey delivery (postal and Web-based) in terms of participation rates, response times, and completeness of questionnaires in a study assessing GPs' preventive practices. METHODS: This randomized study was conducted in Western Switzerland (Geneva and Vaud) and in France (Alsace and Pays de la Loire) in 2015. A random selection of community-based GPs (1000 GPs in Switzerland and 2400 GPs in France) were randomly allocated to receive a questionnaire about preventive care activities either by post (n=700 in Switzerland, n=400 in France) or by email (n=300 in Switzerland, n=2000 in France). Reminder messages were sent once in the postal group and twice in the Web-based group. Any GPs practicing only complementary and alternative medicine were excluded from the study. RESULTS: Among the 3400 contacted GPs, 764 (22.47%, 95% CI 21.07%-23.87%) returned the questionnaire. Compared to the postal group, the participation rate in the Web-based group was more than four times lower (246/2300, 10.70% vs 518/1100, 47.09%, P<.001), but median response time was much shorter (1 day vs 1-3 weeks, P<.001) and the number of GPs having fully completed the questionnaire was almost twice as high (157/246, 63.8% vs 179/518, 34.6%, P<.001). CONCLUSIONS: Web-based surveys offer many advantages such as reduced response time, higher completeness of data, and large cost savings, but our findings suggest that postal surveys can be still considered for GP research. The use of mixed-mode approaches is probably a good strategy to increase GPs' participation in surveys while reducing costs.