Context. Medical office internships in Family Medicine (FM) are now mandatory for students in general medicine. The general practitioners (GP) who host them are called general practitioners supervisors (GPs). Although they are a cornerstone of FM learning, few studies focus exclusively on GPs. The aim of this work was to understand how General Practice Training (GPT) is articulated within the path of the GP. Method. This is a descriptive qualitative study using life-story type interviews with GPs of Yvelines and Hauts de Seine. The study was conducted using a qualitative interpretive phenomenological approach in order to identify a common pattern in the GPS microcosm. Results. 20 GPs were interviewed from January 2019 to July 2020: two main themes were highlighted: For the GPs interviewed, GPT is a component of medicine in the broadest sense: there was a need to promote FM. They developed a militant and committed spirit so as not to reproduce the mistakes of the past. GPT also appeared to be a logical continuation of the professional career of a doctor committed to a group and a territory: meetings and sharing were the pivots of their development as a fulfilled professional, GPT was part of the continuation of a career marked by the refusal of isolation as a means of attracting interns and making them future settled doctors. Conclusion. This work has made it possible to identify how GPT fits into the career path of GP. Further work could explore the hypothesis that the GP trainers group would be born of a gathering of doctors sharing the same interest in training and working in a group practice, even before they became trainers.

Context. General practitioners Supervisors' (GPS) habits remain poorly explored. The practice of GPS could be impacted by hosting and supervising students. Aim. Explore GPs daily work and get information about their organisation since they host students. Method. Qualitative study based on semi-structured one-on-one interviews with GPS following a thematical analysis inspired by phenomenological approach. Results. Twenty interviews have been conducted from January 2019 to July 2020 until data was considered sufficient. Three axes came out: hosting students would allow GPS to commit themselves into dynamic changes that resulted in the emergence of new skills. The student's presence resulted into an optimization of GPS's practices without doing any compromises in their daily work. GP training brought added professional and personal fulfillment to GPs. Conclusion. For the GPs, every change in their daily work seems to be driven by the desire to do well, to consciously commit themselves, and to maintain balance with their own habits, in order to develop a sense of fulfillment. Pointing out these benefits on the GP's daily work could enhance and encourage GPS's recruitment alongside institutions.

Background Depression and anxiety have increased in prevalence since the start of the COVID-19 pandemic.Objective To evaluate the consumption of antidepressants and anxiolytics from 2012 to 2022 and the pandemic’s potential impact in France.Methods We conducted an interrupted time series analysis of routine drug sales data (Medic'AM) from all French outpatient pharmacies from 2012 to 2022. We investigated trends in defined daily doses of antidepressants and anxiolytics sold per 1000 inhabitants (DDD/TID) and related expenditures before and after pandemic onset and in relation with stringency of pandemic mitigation measures. Analyses were performed descriptively and using segmented linear regression, autoregressive and autoregressive integrated moving average models.Findings From 2012 to 2019, overall monthly antidepressant sales increased (+0.02 DDD/TID) while monthly anxiolytic sales decreased (−0.07 DDD/TID). With pandemic onset, there was a relevant and persisting trend increase (+0.20 DDD/TID per month) for antidepressant sales overall, with an estimated excess of 112.6 DDD/TID sold from May 2020 until December 2022. Anxiolytic sales were elevated from February 2020 throughout the pandemic but returned to expected levels by December 2022, with an estimated excess of 33.8 DDD/TID. There was no evident association between stringency and antidepressant or anxiolytic sales.Conclusions This study showed a protracted trend increase in the consumption of antidepressants since pandemic onset, while increases in anxiolytic consumption were temporary.Clinical implications We provide evidence that the COVID-19 pandemic may have had long-lasting consequences on the prevalence and treatment of depression and anxiety disorders, requiring further actions by researchers and policy-makers to address this potential public mental health crisis.

BackgroundAfter a long phase without any propositions for real ambulatory training inside general practitioners' offices, general practice (GP) vocational training has begun to appear progressively and has been integrated into undergraduate medical programmes. The aim of this study was to provide an overview of GP vocational training and GP trainers in member countries of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) Europe.MethodWe carried out this cross-sectional study between September 2018 and March 2020. The participants responded to a questionnaire in real-life conversations, video conferences or e-mail exchanges. The respondents included GP trainers, teachers and general practitioners involved in the GP curriculum recruited during European GP congresses.ResultsRepresentatives from 30 out of 45 WONCA Europe member countries responded to the questionnaire. Based on their responses, there is a well-established period for GP internships in undergraduate medical programmes, but with varying lengths. The programmes for some countries offer an internship after students graduate from medical school but before GP specialisation to ensure the career choice of the trainees. After specialisation, private practice GP internships are offered; however, in-hospital GP internships are more common. GP trainees no longer have a passive role during their internships. GP trainers are selected based on specific criteria and in countries, they have to follow some teacher training programmes. In addition to income from medical appointments carried out by GP trainees, GP trainers from some countries receive additional remuneration from various organisations.ConclusionThis study collected information on how undergraduate and postgraduate medical students are exposed to GP, how GP training is organised and the actual status of GP trainers among WONCA Europe member countries. Our exploration of GP training provides an update of the data collected by Isabel Santos and Vitor Ramos in the 1990s and describes some specificities that can inspire other organisations to prepare young, highly qualified general practitioners.

Objective This study aimed to explore patients’ experiences and perceptions of touch, as practised by their general practitioner during their medical appointment. Design Qualitative study using grounded theory method, based on individual interviews. Data collection and analysis occurred iteratively; themes were identified using constant comparison. Setting Recruitment among general practitioners’ private practices and health centres in Ile-de-France. Participants Twenty-one patients aged 19–88 years old, interviewed between June 2018 and May 2019. Results Physical examination was described as a ritual enabling the establishment of patients’ and doctors’ roles, the verification of the doctor’s skills and the construction of a caring experience. Touch was also a media for the doctor to exercise power that the patient authorised. Finally, it had relational and emotional value. Discussion and conclusion Physical examination is so internalised by the patients that it becomes unquestionable. It may be inappropriate when this touch does not belong to physical examination or on the contrary represents a proof of the doctor’s humanity. The patient is not necessarily aware of the relational dimension that underpins touching and, in particular, clinical examination. This raises the question of why should doctor use it and how they can communicate about it, so that it may become an active tool in favour of trust and the construction of the relationship.

INTRODUCTION:Forty years passed between the two most important definitions of primary health care from Alma Alta Conference in 1978 to WHO's definition in 2018. Since then, reforms of healthcare systems, changes in ambulatory sector and COVID 19, have created a need for reinterpretations and redefinition of primary healthcare. The primary objective of the study was to precise the definitions and the representations of primary healthcare by healthcare professionals.METHODS:We conducted a descriptive cross-sectional study using a web-based anonymized questionnaire including opened-ended and closed-ended questions but also "real-life" case-vignettes to assess participant's perception of primary healthcare, from September to December 2020. Five case-vignette, describing situations involving a specific primary health care professional in a particular place for a determined task were selected, before the study, by test/retest method.RESULTS:A total of 585 healthcare practitioners were included in the study, 29% were general practitioners and 32% were midwives. Amongst proposed healthcare professions, general practitioners (97.6%), nurses (85.3%), midwives (85.2%) and pharmacists (79.3%) were those most associated with primary healthcare. The functions most associated with primary healthcare, with over 90% of approval were "prevention, screening", "education to good health", "orientation in health system". Two case-vignettes strongly emerged as describing a situation of primary healthcare: Midwife/Hospital/Pregnancy (74%) and Pharmacist/Pharmacy/Flu shot (90%). The profession and the modality of practice of the responders lead to diverging answers regarding their primary healthcare representations.CONCLUSIONS:Primary healthcare is an ever-evolving part of the healthcare system, as is its definition. This study explored the perception of primary healthcare by French healthcare practitioners in two complementary ways: oriented way for the important functions and more practical way with the case-vignettes. Understanding their differences of representation, according to their profession and practice offered the authors a first step to a shared and operational version of the primary healthcare definition.

Introduction. Diabetes affects more than 3.3 million French people. Its cost represents nearly 10 billion euros per year, including 250 million in medical biology analyses. According to the recommendations, the monitoring of glycemic control is based on glycated hemoglobin (HbA1c) and not on fasting blood glucose test in the laboratory (FBG). However, it appears that many FBG are prescribed for patients with diabetes. Objective. To assess the cost of potentially inappropriate FBG among diabetic patients in the ambulatory setting.Method. The Echantillon generaliste des beneficiaires (EGB) database was used to include diabetic pa-tients on January 1, 2018. FBG tested in 2018 were searched for. For each FBG, a practice of blood glucose self-monitoring (BGSM) and, according to it, a synchronously prescribed Hba1c or the use of a treatment at risk of hypoglycemia were searched for in order to identify justified FBG. They corresponded either to an annual FBG to check the correct working of the BGSM device, or to FBG tested alone to look for iatrogenic hypoglycemia when no BGSM was performed. The cost of a FBG test was used to obtain the overall cost for the EGB and then for the French population. Results. 40,656 diabetic patients were included and 66,874 FBG were prescribed, of which 52,771 (78.9%) were potentially inappropriate. This represented a cost of 71,240 euro for the EGB, or nearly 7 million euro for the French population. Conclusion. This cost represents only a minor fraction of the health care budget. However, because the iatrogenic impact of repeating potentially inappropriate FBG has not been studied, it would be interesting to investigate the issue of multiple testing in patients with type 2 diabetes.

Context. In the fight against medical overuse, a French Top Five List has recently listed 5 medicals services frequently prescribed in family practice, despite unfavourable benefit-risk ratio. One of those was antibiotherapy. Objective. Synthetizing data of scientific literature about efficacy and safety of antibiotic use in uncomplicated influenza, acute bronchitis, seromucous otitis and acute rhinopharyngitis, into guides for the practitioners involved in the study of the "Top five list". Methods. Systematic reviews, meta-analysis of randomised controlled trial (RCT), RCT versus placebo, and observational studies were included. The databases consulted were Medline, Embase and the Cochrane Library. After quality assessment using reading grids, the most relevant studies were selected for the realization of guides. Results. Among 5 296 articles, 3 meta-analysis and 1 prospective cohort study were selected. There is no significant difference between antibiotics and placebo for treatment of uncomplicated influenza and acute rhinopharyngitis. For acute bronchitis, antibiotics reduce duration of days of cough (RR= -0.55 ; 95CI = -1.00 - -0.10). For seromucous otitis, antibiotics improve complete resolution on tympanometry at two to three months (NNT = 5), but studies on hearing levels shown incomplete and conflicting results. Antibiotics expose to side effects (NNH = 24). Conclusion. Antibiotics' prescription seems to not have clinical interest for the treatment of uncomplicated influenza, acute bronchitis of healthy subject, seromucous otitis and acute rhinopharyngitis.

Background. The safety of non-steroids anti-inflammatory drugs (NSAIDs) in the context of pharyngitis is doubtful with contradictory results in the literature. Objective. To evaluate the risk of peritonsillar abscess (PTA) associated to NSAIDs consumption during a pharyngitis episode observed in primary care. Method. A retrospective cohort study using Observatory of General Medicine Datalink from 1995 to 2010. All patients consulting a GP from the Datalink network for pharyngitis have been included. The occurrence of a PTA in the 15 days following the consultation for pharyngitis was matched. The association between PTA and prescriptions of NSAIDs was studied via an adjusted logistic regression model. Results. During the study period, 105 802 cases of pharyngitis and 48 cases of PTA following a pharyngitis were reported, concerning respectively 67 765 and 47 patients. In the multivariate analysis, the risk of PTA was associated positively with a NSAIDs prescription (OR = 2.9, 95% CI = 1.6-5.2). Other factors associated with PTA occurrence were the prescription of corticosteroids (OR = 3.1, 95% CI = 1.3-7.6) and an age between 20 and 40 years (OR = 5.7, 95% CI = 2.5-13.0). The prescription of antibiotics was not significantly associated with PTA (P = 0.7). Conclusion. Prescription of NSAIDs in pharyngitis may increase the risk of PTA. This study encourages considering cautiously the balance between benefits and harms before prescription of NSAIDs for pharyngitis.

Purpose Antibiotic prescription is a central public health issue. Overall, 90% of antibiotic prescriptions are delivered to patients in ambulatory care, and a substantial proportion of these prescriptions could be avoided. General Practitioner (GP) trainers are similar to other GPs in terms of sociodemographic and medical activities, but they may have different prescription patterns. Our aim was to compare the antibiotic prescribing rates between GP trainers and non-trainers. Methods This observational cross-sectional study was conducted on administrative data claims from the French National Health Insurance. The antibiotic prescribing rate was calculated. The main independent variable was the training status of the GPs. Prescribing rates were adjusted for the various GPs’ characteristics (gender, age, location of the practice, number of visits per GP and the case-mix) in a multiple linear regression analysis. Results Between June 2014 and July 2015 the prescribing patterns of 860 GPs were analysed, among which 102 were GP trainers (12%). Over the year 363,580 patients were prescribed an antibiotic out of 3,499,248 visits for 1,299,308 patients seen over the year thus representing around 27.5% of patients. In the multivariate analyses, being a trainer resulted in a significant difference of 6.62 percentage points (IC 95%: [-8.55; -4.69]; p<0.001) in antibiotic prescriptions comparing to being a non-trainer, corresponding to a relative reduction of 23.4%. Conclusion These findings highlight the role of GP trainers in antibiotic prescriptions. By prescribing fewer antibiotics and influencing the next generations of GPs, the human and economic burden of antibiotics could be reduced.