[General Practice: continuously developing]. / Huisartsgeneeskunde: continu in ontwikkeling.

Over the past 10 years there have been significant developments in general practice regarding diagnostics, differentiation of competences of general practitioners, cooperation within primary care and with secondary care, task delegation and patient information provision. Less progress has been made in other areas: E-health applications are rarely used, and there is no clear guideline for an integrated policy in patients with multimorbidity. General practitioners also continue to suffer from excessive regulatory pressure, excessive protocols and standardization. In the coming decade, GPs will continue to work in accordance with the core values ​​of their profession: 'person-oriented', 'medical-generalist', 'continuous' and 'jointly'. Their function to provide guidance is becoming increasingly important. In addition, more diagnostics and treatment will take place at the interface between general practice and secondary care. Chronic care will focus more on the needs and wishes of the individual patient. GPs retain their important role in terminal palliative care and emergency care.

Changing general medical practices in the management of neuropathic pain / Évolution des pratiques en médecine générale dans la prise en charge des douleurs neuropathiques.

Objective: The objective of this study was to determine current practices in the Lorraine region in the treatment of neuropathic pain and to assess the challenges faced by general practitioners (GPs). Methods: We conducted a qualitative study by the focus group technique, by constituting a balanced panel of GPs to meet diversification requirements. The number of focus groups was defined to obtain data saturation. The lead author of this study acted as an observer, while a facilitator was responsible for moderating the debate. Analysis of transcripts was performed in two ways: firstly, several readings of the transcripts to highlight the main ideas emerging from these discussions, and secondly, integration of verbatim transcripts in NVivo 10 software to allow complementary computer analysis. Results: The GPs interviewed reported that they prescribed Clonazepam (Rivotril®), Carbamazepine (Tegretol®) and Amitriptyline (Laroxyl®) less often than ten years ago, and Gabapentin (Neurontin®), Pregabalin (Lyrica®), Venlafaxin (Effexor®) and Duloxetine (Cymbalta®) more often than ten years ago. They reported many difficulties in the daily management of these patients, especially concerning the psychological or psychiatric components associated with this pain, comorbidities, iatrogenic effects, the inefficacy of the available molecules, the difficulties of access to a specialist (including pain centres), acceptance of treatment by patients, limiting requirements (restrictive marketing authorisations, withdrawal of certain products…). Conclusion: The treatment of neuropathic pain raises a number of difficulties for GPs, but changes in prescribing habits reflect a constant adaptation of clinical practices.

Staying at work with back pain: patients' experiences of work-related help received from GPs and other clinicians. A qualitative study.

BACKGROUND: Low back pain commonly affects work ability, but little is known about the work-related help and advice that patients receive from GPs and other clinicians. The purpose of this study was to explore the experiences of employed people with back pain and their perceptions of how GPs and other clinicians have addressed their work difficulties. METHODS: A qualitative approach with thematic analysis was used. Individual interviews were carried out with twenty-five employed patients who had been referred for back pain rehabilitation. All had expressed concern about their ability to work due to low back pain. RESULTS: The perception of the participants was that GPs and other clinicians had provided little or no work-focused guidance and support and rarely communicated with employers. Sickness certification was the main method that GPs used to manage participants' work problems. Few had received assistance with temporary modifications and many participants had remained in work despite the advice they had received. There was little expectation of what GPs and other clinicians could offer to address work issues. CONCLUSIONS: These findings question the ability of GPs and other clinicians to provide work-focused support and advice to patients with low back pain. Future research is recommended to explore how the workplace problems of patients can be best addressed by health professionals.