Impact of a Doctor's Invitation on Participation in Colorectal Cancer Screening: A Cluster Randomized Trial.

BACKGROUND: There is a need to improve participation in colorectal cancer screening. Our objective was to assess the impact of a signature from the patient's general practitioner on a letter inviting patients to participate in a colorectal cancer screening. METHOD: We conducted a cluster randomized controlled trial with 57 general practitioners established in Paris for more than 5 years, randomized to intervention or usual-care arms. There were 3422 patients included, ages 50-74 years, from general practitioner patient files, and eligible for an invitation letter or a reminder letter to participate in the national population-based screening program. In the intervention arm, patients received a standard letter signed by their general practitioner inviting them to visit the general practitioner's office for a fecal occult blood test if they were eligible. Control patients received the standard invitation letter or the standard reminder. All letters were sent by the district screening organization. The main outcome was the proportion of patients who took the fecal occult blood test within 6 months after the invitation. RESULTS: Among patients eligible for the study, 508 (14.8%) took a fecal occult blood test after being invited; 285 (15%; 95% confidence interval [CI], 13.5-16.7) in the intervention group and 223 (14.6%; 95% CI, 12.9-16.5) in the control group, with no statistical difference between the 2 groups (odds ratio 1.04; 95% CI, 0.83-1.31; P = .731). CONCLUSIONS: The addition of a general practitioner's signature to a standard letter inviting patients to take a fecal occult blood test had no impact on the frequency of patients taking the fecal occult blood test in the Paris program of colorectal cancer screening.

[French general practitioners' perceptions and use of neuraminidase inhibitors during the pandemic A(H1N1)2009 influenza]. / Médicaments antiviraux spécifiques de la grippe pendant la pandémie A(H1N1)2009 : usage et perception des médecins généralistes français.

The purpose of this study is to describe the perception of neuraminidase inhibitors (NAIs) during the pandemic A(H1N1)2009 influenza among general practitioners. A survey was conducted between 15 July and 15 September 2010 among a random sample of metropolitan French GPs. Among the 161 respondents, only 6% reported that they "often" prescribed NAIs during the pandemic A(H1N1)2009 influenza, while 69% reported that they prescribed NAIs "from time to time". The main objectives of GPs were to limit the risk of complications and the duration of symptoms. The main predictor of prescription of neuraminidase inhibitors during the pandemic A(H1N1)2009 influenza was the prescription of NAIs during epidemic seasonal periods (OR = 3.23 [95% CI 1.3 to 8.8]). Barriers to the prescription of NAIs were an estimated lack of efficacy (64%) and a negative benefit/risk balance (52%). Among the GPs surveyed in this research, 62% reported that they had been vaccinated against influenza A(H1N1)2009, while 73% recommended vaccination. GPs who prescribed NAIs during the pandemic A(H1N1)2009 influenza were those who prescribed NAIs during a seasonal influenza epidemic. To improve the outpatient prescription of NAIs during pandemic outbreaks, more knowledge about NAIs is required during seasonal influenza.

[Highly pathogenic influenza pandemic: results of a feasibility study in a general practice (SIMUGRIP-MG2)]. / Pandémie grippale à virus hautement pathogène : étude de faisabilité en cabinet (SIMUGRIP-MG2).

The French Pandemic Influenza Plan ("Plan National de Prévention et de Lutte Pandémie Grippale") places general practitioners at the heart of the provision of care to patients through consultations and house calls. The purpose of this study was to determine whether GP practices are able to provide treatment to flu patients within their premises in the event of a highly pathogenic influenza pandemic. A simulation exercise conducted in a GP practice (SIMUGRIP-MG2) was carried out in the autumn of 2009. 3 general practitioners, the practice secretary, 33 patients and care staff took part in the exercise during a half day of practice. The study found that the quality of some hygiene practices and procedures was inadequate: the duration of handwashing was too short (mean: 11.8 seconds), gloves were not worn, and FFP2 masks were often handled. The study found that the implementation of these procedures required increased effort and attention from GPs. It was also found that this type of consultation requires additional preparation time (refitting, supply of materials) and generates additional costs (linked, for example, to storage issues). In seeking to improve the quality of care provided to infected patients in the event of an influenza pandemic, several factors must be considered, including recent data on the effectiveness of countermeasures, additional training to improve hygiene practices, and infrastructure modernization to improve ergonomics in GP practices.

[A simulation exercise in a flu clinic]. / Exercice sur le terrain dans un Centre de Consultation Dédié à la grippe (SIMUGRIP-MG1).

A simulation exercise aimed at assessing the management and provision of ambulatory care in the context of a highly pathogenic influenza pandemic was conducted in a specifically dedicated consultation center (Centre de Consultation Dédié (CCD) à la grippe) based on official French guidelines. The exercise was carried out in a school in Paris equipped to simulate a "flu clinic". 3 practitioners provided treatment lasting 2 hours to nursing students acting as patients. The exercise highlighted a number of major organizational issues. Staff were found to be unable to manage the center and to perform patient transfers; face masks were not routinely and consistently worn by doctors and patients; and communication between professionals within the clinic was limited. The exercise showed that much remains to be done to ensure that "flu clinics" are effective and functional. The results suggest that the exercise will need to be repeated on a larger scale and over a longer period.

[A survey about determinants of 2009 pandemic influenza A(H1N1) vaccination among French general practionners patients. Motivac study]. / Déterminants de la vaccination contre la grippe A(H1N1) 2009. Enquête auprès des patients de médecins généralistes français. Etude Motivac.

The influenza A/H1N1 2009 immunization campaign did not have the accession of the French population resulting in a very low rate of immunization coverage. We conducted a cross-sectional study in spring 2010 to identify factors that led general practitionners (GPs) and their adult patients to be vaccinated or not; 43 GPs in France, included 668 patients; 29 GPs (67%) and 108 patients (16.5%) have been vaccinated; among 238 patients under vaccine priority indication 17% were vaccinated; 48% of patients thought they could receive effective treatment for influenza, 36% felt that the vaccine protected against influenza but 27% thought it did not meet usual safety criteria. A higher level of education, the belief of an effective protection with vaccination, the positive GP's opinion and behavior (OR 4,21 IC95% [1.4-14]; p=0.012), the receipt of an invitation to immunization (OR 7, 1 IC95% [1.73-58.4] and the active seek of information (OR 8.05, IC95% [2.8-27]) were significantly associated with vaccination. Regarding this immunization campaign few patients n=87 (13.7%) did trust the state heath agency. Our study confirms the distrust of the vaccine and suggests the decisive role of the GPs to achieve adequate levels of immunization coverage.