[The practice and acceptance of physician preventive medicine services in a Montreal university hospital and the obstacles that deter their implementation.]. / Pratiques cliniques préventives et besoins pour leur intégration chez des médecins d'un centre hospitalier universitaire a Montréal.

OBJECTIVES: Present a picture of physicians' preventive clinical practices (PCP) at a university medical centre, and identify the obstacles that hinder their implementation. METHOD: Self-administered questionnaire survey addressed to 367 general practitioners and specialists working at the Centre hospitalier de l'Université de Montréal (CHUM) in 2006. RESULTS: Respondents claim to be recommending PCP (often or very often) in approximately 60-82% of cases. Women physicians report a larger integration for screening and vaccination (p < 0.05). General physicians claim to apply or recommend PCP more frequently than specialists (p < 0.05), except for anti-tobacco counseling. Lack of time (82%) and deficiencies in continuity of treatment (75%) are considered by the majority of respondents as major obstacles to the realization of PCP. Most participants (99%) consider delivering preventive services to be part of their role and 98% claim to be motivated to integrate PCP into their practice. However, almost half of physicians do not apply preventive recommendations to their own life and at least two thirds of them doubt the efficacy of counseling. CONCLUSION: Despite observed encouraging results, actions must be taken to improve the integration of PCP to general and specialized health care and to bring physicians around to adopting healthy lifestyle habits themselves.

Effectiveness of stop smoking interventions among adults: protocol for an overview of systematic reviews and an updated systematic review.

BACKGROUND: Tobacco smoking is the leading cause of cancer, preventable death, and disability. Smoking cessation can increase life expectancy by nearly a decade if achieved in the third or fourth decades of life. Various stop smoking interventions are available including pharmacotherapies, electronic cigarettes, behavioural support, and alternative therapies. This protocol outlines an evidence review which will evaluate the benefits and harms of stop smoking interventions in adults. METHODS: The evidence review will consist of two stages. First, an overview of systematic reviews evaluating the benefits and harms of various stop smoking interventions delivered in or referred from the primary care setting will be conducted. The second stage will involve updating a systematic review on electronic cigarettes identified in the overview; randomized controlled trials will be considered for outcomes relating to benefits while randomized controlled trials, non-randomized controlled trials, and comparative observational studies will be considered for evaluating harms. Search strategies will be developed and peer-reviewed by medical information specialists. The search strategy for the updated review on e-cigarettes will be developed using that of the candidate systematic review. The MEDLINE®, PsycINFO, Embase, and the Cochrane Library electronic databases will be searched as of 2008 for the overview of reviews and from the last search date of the selected review for the updated review. Organizational websites and trial registries will be searched for unpublished or ongoing reviews/studies. Two reviewers will independently screen the title and abstracts of citations using the liberal accelerated method. Full-text screening will be performed independently by two reviewers. Extracted data will be verified by a second reviewer. Disagreements regarding full-text screening and data extraction will be resolved by consensus or third-party adjudication. The methodological quality of systematic reviews, risk of bias of randomized and non-randomized trials, and methodological quality of cohort studies will be evaluated using AMSTAR 2, the Cochrane risk of bias tool, and a modified version of the Scottish Intercollegiate Guidelines Network critical appraisal tool, respectively. The GRADE framework will be used to assess the quality of the evidence for outcomes. DISCUSSION: The evidence review will evaluate the benefits and harms of various stop smoking interventions for adults. Findings will be used to inform a national tobacco cessation guideline by the Canadian Task Force on Preventive Health Care. SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD42018099691, CRD42018099692).

[Do you counsel your patients on their health behaviors?]. / Les médecins discutent-ils des habitudes de vie avec leurs patients?

OBJECTIVE: To document counselling practices of general practitioners concerning lifestyle habits in the Capitale-Nationale region (Quebec City and area), from the patient's perspective. METHOD: A cross-sectional telephone survey was carried out in 2006 among 482 patients (18-74 years of age) recruited in 11 medical clinics employing 84 general practitioners. RESULTS: At the visit immediately following the recruitment, 37% of participants reported having discussed smoking with their physician, 10% fruit and vegetable consumption and 33% physical activity. The prevalence of counselling on lifestyle habits increased as a function of pre-existing pathology. Participants said they were favourable to receiving advice on their habits in a proportion that varied from 82% (walk-in clinics) to 99% (health check) and 85% of them would modify their lifestyle habits if the advice was given by a physician (only 76% among smokers, p < 0.0001). DISCUSSION/CONCLUSION: Even if they play a key role in chronic disease prevention, lifestyle habits were discussed in only 10 to 37% of medical visits and especially with patients who already had chronic disease or associated risk factors. Patients were very receptive to receiving advice on their lifestyle habits, even in walk-in clinics. It is now imperative to support general practitioners in the promotion of healthy lifestyle habits with all patients.

Does Receiving Clinical Preventive Services Vary across Different Types of Primary Healthcare Organizations? Evidence from a Population-Based Survey.

OBJECTIVE: To measure the association between primary healthcare (PHC) organizational types and patient coverage for clinical preventive services (CPS). METHOD: Study conducted in Quebec (2005), including a population-based survey of patients' experience of care (N=4,417) and a survey of PHC clinics. OUTCOME MEASURES: Patient-reported CPS delivery rates and CPS coverage scores. Multiple logistic regressions used to assess factors associated with higher probability of receiving CPS. RESULTS: CPS delivery rates were higher among patients with a regular source of PHC. Higher CPS score was associated with having a public (OR 1.79; 95% CI 1.35-2.37) or mixed (OR 1.22; 95% CI 1.01-1.48) type of organization as source of PHC compared to a private one, and having had a high number of visits to the regular source of PHC in the past two years (≤6: OR 1.83; 95% CI 1.41-2.38) compared to a single visit. CONCLUSION: Public and mixed PHC organizations seem to perform better. CPS delivery is strongly associated with having a regular source of care.