Potentially Inappropriate Drug Prescribing in French Nursing Home Residents: An Observational Study.

Purpose: To identify the prevalence of potentially inappropriate drug prescription in a sample of nursing home residents in France, combining explicit criteria and implicit approach and to involve pharmacists in the multi-professional process of therapeutic optimization. Methods: A cross-sectional, observational, multicenter study was conducted during a five-month period in a sample of French nursing homes. Information on drug prescription, diseases, and socio-demographic characteristics of nursing home residents was collected. For each prescription, identification of potentially inappropriate drug prescription was done, based on explicit and implicit criteria. Results: Nursing home residents were administered an average of 8.1 (SD 3.2, range 0-20) drugs per day. Nearly 87% (n = 237) of the residents had polypharmacy with five or more drugs prescribed per day. Among the 274 nursing home residents recruited from five nursing homes, 212 (77.4%) had at least one potentially inappropriate drug prescription. According to the Laroche list, 84 residents (30.7%) had at least one drug with an unfavorable benefit-harm balance. An overdosing was found for 20.1% (n = 55) of the residents. Nearly 30% (n = 82) of the residents had a drug prescribed without valid medical indication. Conclusions: This study shows that potentially inappropriate drug prescriptions are highly prevalent among nursing home residents, nevertheless pharmacists can take part in drug utilization review in collaboration with the nursing home staff.

Evolution of Reactions to Uncertainty Among Residents During a Clinical Rotation.

BACKGROUND AND OBJECTIVES: For residents, uncertainty can be a source of motivation, interest, and stimulation, but it can also cause fear and anxiety that can lead to burn-out. Considering the prevalence of uncertainty in family medicine and the potential reactions from residents, reactions to uncertainty constitute an important research topic. This study sought to measure the evolution of reactions to uncertainty of family medicine residents in their first and second year, during a 6-month clinical rotation in a family physician's office. METHODS: This study utilized a prospective epidemiological cohort design of first- and second-year family medicine residents during a 6-month clinical rotation in a family physician's office during the 2018-2019 academic year. Data were collected at the beginning and end of the clinical rotation for the entire student population using the Physicians' Reactions to Uncertainty (PRU) questionnaire. RESULTS: One hundred-two respondents were matched at the end of the clinical rotation and were included in the analysis. At baseline, there were no significant differences between first- and second-year residents in each dimension of the PRU. Anxiety due to uncertainty decreased significantly in residents of both years. Concern about bad outcomes decreased, but not significantly, in both years. Reluctance to disclose uncertainty to patients decreased in first-year residents. CONCLUSIONS: During a 6-month clinical rotation, anxiety due to uncertainty decreased in first- and second-year residents. The frequency and the type of uncertain situations residents encountered could be investigated in future studies to better understand residents' reactions to uncertainty.

Becoming frail: a major turning point in patients' life course.

BACKGROUND: The frailty concept requires that practices should be adapted to meet the challenge of dependence. The GP is in the front line of management of frail elderly patients. OBJECTIVES: To explore the perception of elderly persons of the term and concept of frailty and to understand their perception of the risk of loss of independence. METHODS: Two qualitative studies by individual interviews in the homes of elderly persons identified as potentially frail by their GP, or diagnosed as frail and at risk of loss of independence. The sampling was theoretical. The analysis was carried out using an inductive approach following the phases of thematic analysis. The researchers used triangulation and collection was concluded when theoretical saturation had been reached. RESULTS: The concept of frailty was seen as forming an integral part of physiological ageing and appeared to be irreversible. The term of frailty had a negative connotation. The physical, cognitive and psychological components of frailty were present in the participants' discourse. Nutritional and sensory components were less present. Frailty due to inappropriate medication was not cited. Seven risk factors for loss of independence were identified: social isolation, poor physical health, poor mental health, loss of mobility, unsuitable living conditions, unsuitable environment, and low resources. CONCLUSIONS: Becoming frail is a major turning point in patients' life course. Coordinated multiprofessional management that takes account of patients' perceptions could help in negotiating a feasible care plan adapted to the patient's needs.

Reliability and validity of the script concordance test for postgraduate students of general practice.

BACKGROUND: The script concordance test (SCT) is a validated method of examining students' clinical reasoning. Medical students' professional skills are assessed during their postgraduate years as they study for a specialist qualification in general practice. However, no specific provision is made for assessing their clinical reasoning during their postgraduate study. OBJECTIVE: The aim was to demonstrate the reliability and validity of the SCT in general practice and to determine if this tool could be used to assess medical students' progress in acquiring clinical reasoning. METHODS: A 135-question SCT was administered to postgraduate medical students at the beginning of their first year of specialized training in general practice, and then every six months throughout their three-year training, as well as to a reference panel of 20 expert general practitioners. For score calculation, we used the combined scoring method as the calculator made available by the University of Montreal's School of Medicine in Canada. For the validity, student' scores were compared with experts, p <.05 was considered statistically significant. RESULTS: Ninety students completed all six assessments. The experts' mean score (76.7/100) was significantly higher than the students' score across all assessments (p <.001), with a Cronbach's alpha value of over 0.65 for all assessments. CONCLUSION: The SCT was found to be reliable and capable of discriminating between students and experts, demonstrating that this test is a valid tool for assessing clinical reasoning skills in general practice.

French general practitioners' sense of isolation in the management of elderly cancer patients.

BACKGROUND: Cancer care in people over 75 years of age is particularly complex and requires collaboration between oncologists, geriatricians, GPs and other professional and family carers. To improve the care pathways for elderly people living with cancer, the French health authorities have created a network of oncologists and geriatricians; however, GPs experience difficulties in establishing their place in this network. OBJECTIVE: This study aimed to analyse the impressions of French GPs involved in the care of elderly patients with cancer, including their feelings regarding their relationships with their oncologist and geriatrician colleagues. METHODS: A qualitative approach using focus groups was employed. The proceedings of these focus groups were recorded, retranscribed and subjected to thematic analysis. RESULTS: Although heavily involved in the care of their elderly patients living with cancer, the GPs who participated reported feeling isolated in their role at each step during the course of the disease. The principal themes addressed were screening and diagnosis, therapeutic decisions, multidisciplinary consultation meetings, the announcement of the diagnosis and monitoring at home. Their relationships with their oncologist colleagues showed much room for improvement, and they were unaware of the oncogeriatric network. CONCLUSIONS: Improving the communication between GPs, oncologists and geriatric medicine seems to be one response to the isolation that GPs feel when caring for older people with cancer. At the primary care level, integration of GPs into the oncogeriatric network and the creation of a cancer care communication system in collaboration with the relevant hospital teams may be effective solutions.