How do general practitioners put preventive care recommendations into practice? A cross-sectional study in Switzerland and France

• Published in: BMJ open 2017-10, Vol.7 (10), p.e017958-e017958
• Main Authors: Sebo, Paul, Cerutti, Bernard, Fournier, Jean-Pascal, Rat, Cédric, Rougerie, Fabien, Senn, Nicolas, Haller, Dagmar M, Maisonneuve, Hubert
• Format: Article
• Language: English
• Subjects: Adult; Adult Aged Aged, 80 and over Alcohol-Related Disorders / prevention & control Attitude of Health Personnel Colorectal Neoplasms / prevention & control Cross-Sectional Studies Dyslipidemias / prevention & control Female France General Practice General Practitioners Guideline Adherence Guidelines as Topic Humans Male Middle Aged Practice Patterns, Physicians' Preventive Medicine / methods Primary Prevention / methods Prostatic Neoplasms / prevention & control Surveys and Questionnaires Switzerland; Aged; Aged, 80 and over; Alcohol-Related Disorders - prevention & control; Attitude of Health Personnel; Cancer; Cardiovascular disease; Chronic illnesses; Colorectal Neoplasms - prevention & control; Cross-Sectional Studies; Disease prevention; Dyslipidemias - prevention & control; Family physicians; Female; France; General Practice; General practice / Family practice; General Practitioners; Guideline Adherence; Guidelines as Topic; Health care; Human health and pathology; Humans; Life Sciences; Male; Medical screening; Middle Aged; Practice Patterns, Physicians; Preventive medicine; Preventive Medicine - methods; Primary care; Primary Prevention - methods; Prostate cancer; Prostatic Neoplasms - prevention & control; Surveys and Questionnaires; Switzerland; Task forces
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2017-017958

ObjectivesWe previously identified that general practitioners (GPs) in French-speaking regions of Europe had a variable uptake of common preventive recommendations. In this study, we describe GPs’ reports of how they put different preventive recommendations into practice.Design, setting and participantsCross-sectional study conducted in 2015 in Switzerland and France. 3400 randomly selected GPs were asked to complete a postal (n=1100) or online (n=2300) questionnaire. GPs who exclusively practiced complementary and alternative medicine were not eligible for the study. 764 GPs (response rate: postal 47%, online 11%) returned the questionnaire (428 in Switzerland and 336 in France).Main outcome measuresWe investigated how the GPs performed five preventive practices (screening for dyslipidaemia, colorectal and prostate cancer, identification of hazardous alcohol consumption and brief intervention), examining which age group they selected, the screening frequency, the test they used, whether they favoured shared decision for prostate cancer screening and their definition of hazardous alcohol use.ResultsA large variability was observed in the way in which GPs provide these practices. 41% reported screening yearly for cholesterol, starting and stopping at variable ages. 82% did not use any test to identify hazardous drinking. The most common responses for defining hazardous drinking were, for men, ≥21 drinks/week (24%) and ≥4 drinks/occasion for binge drinking (20%), and for women, ≥14 drinks/week (28%) and ≥3 drinks/occasion (21%). Screening for colorectal cancer, mainly with colonoscopy in Switzerland (86%) and stool-based tests in France (93%), was provided every 10 years in Switzerland (65%) and 2 years in France (91%) to patients between 50 years (87%) and 75 years (67%). Prostate cancer screening, usually with shared decision (82%), was provided yearly (62%) to patients between 50 years (74%) and 75–80 years (32%–34%).ConclusionsThe large diversity in the way these practices are provided needs to be addressed, as it could be related to some misunderstandingof the current guidelines, to barriers for guideline uptake or, more likely, to the absence of agreement between the various recommendations.