Effectiveness of coordinated care to reduce the risk of prolonged disability among patients suffering from subacute or recurrent acute low back pain in primary care: protocol of the CO.LOMB cluster-randomized, controlled study.

Background: Low back pain (LBP) is a common musculoskeletal condition and, globally, a leading cause of years lived with disability. It leads to reduced social participation, impaired quality of life, and direct and indirect costs due to work incapacity. A coordinated approach focusing on psychosocial risk factors, active reeducation, and the early use of tools to maintain employment, may be effective for improving prognosis of patients with LBP. Primary care professionals and multidisciplinary teams, who see patients in the early stages of LBP may be in the best position to implement such a coordinated approach. We designed this study to assess a coordinated multi-faceted strategy in primary care for patients with subacute or recurrent acute LBP. Methods: The CO.LOMB study was designed as a multicentric, cluster-randomized, controlled study. Patients aged 18-60 years, with subacute or recurrent acute LBP are eligible. Patients also need to be employed (but can be on sick leave) with access to occupational health services. The clusters of GPs will be randomized (1:1) to either the Coordinated-care group or the Usual-care group. Patients will be assigned the group allocated to their GP. The healthcare professionals (GPs and associated physiotherapists) allocated to the Coordinated-care group will perform a 2-session study training. The following interventions are planned in the Coordinated-care group: exploration and management of psychosocial factors, active reeducation with a physiotherapist, the implementing of tools to maintain employment, and a reinforced cooperation between primary healthcare professionals. The primary objective is to assess the benefit of coordinated primary care to reduce disability in LBP patients at 12 months after enrollment: measure using the validated French version of the Roland Morris Disability Questionnaire. Secondary objectives include the evaluation of pain, work status, and quality of life at various time points. The study plans to enroll 500 patients in 20 GP clusters. Patients will be followed up for 12months. Discussion: This study will evaluate the benefit of a coordinated multi-faceted strategy in primary care for patients with LBP. Notably whether this approach will alleviate the associated disability, attenuate pain, and promote the maintenance or return to work. Clinical Trial Registration: NCT04826757.

The expectations of transgender people in the face of their health-care access difficulties and how they can be overcome. A qualitative study in France.

AIM: Our objective was to explore the difficulties experienced by transgender people in accessing primary health-care services and their expectations towards primary care providers to improve their health-care access. BACKGROUND: Because transgender people are exposed to many discriminations, their health-care access is particularly poor. Guidelines recommend greater involvement of primary care providers in the processes because of the accessibility feature of primary care services. METHODS: A qualitative study using semi-directed interviews was conducted among 27 transgender people (February 2018 - August 2018). These voluntary participants were recruited through different means: local trans or LGBTI (lesbian, gay, bisexual, trans, and/or intersex) associations, primary care providers, and social networks. The data analysis was based on reflexive thematic analysis in an inductive approach. FINDINGS: Difficulties in accessing health-care occurred at all the levels of the primary health-care system: primary care providers - transgender people interaction, access to the primary care team facility (starting with the secretariat), access to secondary care specialists, and continuity of care. Transgender people report ill-adapted health-care services as a result of gender-based identification in health-care settings. Their main expectation was depsychiatrization and self-determination. They supported mixed health network comprising primary care providers and transgender people with a coordinating role for the general practitioner. These expectations should be priorities to consider in our primary health-care system to improve access to health-care for transgender people.

[Health expectations of the inhabitants of a health priority area: a qualitative study]. / Les attentes d'usagers d'un quartier prioritaire en termes de santé : une enquête qualitative.

INTRODUCTION: French law of 4 March 2002 instituted health democracy, making health system users a real partner and active stakeholder in the healthcare system. This role of health system users must be taken into account particularly in health priority areas in order to reduce social inequalities in health. In the context of primary care, multidisciplinary clinics would appear to be ideal places to develop the expression of health democracy. OBJECTIVE: Identify the health expectations of the users of the Villejean clinic (Brittany, France) situated in a health priority area. METHOD: Qualitative study based on individual and group interviews, conducted with Villejean health system users. Transcripts were analysed thematically by a grounded theory approach. RESULTS: Five group interviews and twenty-one individual interviews were conducted in 49 users. The interviewees described high expectations in terms of a quality relationship with healthcare professionals, who were considered to be real educative partners. Users also formulated high expectations in relation to facilitated access to cares, especially concerning financial aspects. CONCLUSION: Identification of users' expectations constitutes the first step in developing a primary care health democracy, in which access to care is a major priority. New multidisciplinary clinic projects must take these users' expectations into account. The creation of user committees could allow the citizen-users' views to be really taken into account.