MEDICAL PRACTICE WITHIN THE PRIMARY HEALTH CARE CONTEXT. Characteristics and new trends

##plugins.themes.academic_pro.article.main##

Med Lassaad Latrech
Med Ellias Latrech
Raoudha Ben Hafsa
Khédija Najahi
Houda Saied

Abstract

Background : The request for a high quality clinical practice is a permanent challenge. Many conclusions have been drawn concerning the medical care and the results variability and the drifts cost. Within this context the General Practitioner has to maintain and improve his performance.
Aim: To asse the agreement of primary care physicians with new trends in the specialized literature Methods : A survey via an auto-questionnaire comprising 20  items was addressed to 50 General Practitioners of the Public Health Sector, draw chosen, in order to provide their opinion, knowledge and know-how relative to certain aspects of their daily activity.
Results: The General Practitioners’ estimation of the average time for a consultation is 10 minutes; the reasons of its prolongation are the poly-pathologies, the unexplained medical symptoms and the extreme aged patients. The preferred anamnesis strategy is followed by the global method; in the relationship General Practitioner - Patient the medical aspect is prevailing on the centred patient approach (psycho - socio-medical). The majority of General Practitioners are behaving more as teachers and advisors than as technicians and tutors. The non – explained medical symptoms are merely corresponding to psychosomatic
pathologies and hidden complaints. The sanitary information promotion consists, in priority, in the use of a standard classification and then in the electronic activity registration.
Conclusion: Our study allowed us to confirm a certain clash between our General Practitioners’ practice and the new trends in the specialized literature. The validity of these results remains though dependant of a survey to be done with the Patients.

Keywords:

Medical practice, Primary health care

##plugins.themes.academic_pro.article.details##

References

  1. Nichols L, Aronica P, Babe C. Are autopsies obsolete? Am. J. Clin Pathol 1996; 110: 210-8
  2. Burton EC, Troxclair DA, Newman WP. Autopsies diagnoses of malignant neoplasms. How often are clinical diagnoses incorrect? JAMA 1998; 280: 1245-8
  3. Smith. P C, Araya-guerra. R, Bublitz C et al. Missing clinical information during primary care visits. Jama 2005; 293: 565-71
  4. Ramsey P.G, Curtis J R, Paaum D S et al. History-taking and preventive skills among primary care physicians: an assessment using standardized patients. Am J Med 1998; 104: 152-58
  5. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reaction in hospitalized patients: a meta analysis of prospective studies. JAMA 1998; 279: 1200-5
  6. De la Sierra A, Cardellach F, Cobo E et al. Iatrogenic illness in a department of general internal medicine. A prospective study. Mt Sinai J Med 1989; 56 :267-71
  7. Ghandi T K, Weingart SN, Borus J et al. Adverse drug events in ambulatory care. N. Engl. J .Med. 2003; 348: 1556-64
  8. Domenighetti G, Casabianca A. Rate of hysterectomy is lower among female doctors and lawyers wives. B M J. 1997; 314: 1417.
  9. Seematter-Bagnoud L, Vader J P, Wietlisbach V et al. Overuse and underuse of diagnostic upper gastrointestinal endoscopy in various clinical settings. Int J Qual Health Care 1999; 11: 301- 8.
  10. Vader JP, Pache I, Froehlich F et al. Overuse and underuse of colonoscopy in a European primary care setting. Gastrointest Endosc 2000; 52: 593-9
  11. Holland J C. Use of alternative medicine - a marker of distress. N Engl J Med 1999; 340: 1758-9.
  12. Astin J A, Why patients use alternative medicine. Results of a national study. Jama 1998; 279: 1548-53.
  13. Léonard D. Expert généraliste, Quelles sont les compétences requises. La revue du praticien M G 2004; 18: 1055-56
  14. Druais P l, Gilberg S. Le DES de médecine générale. La revue du praticien M G 2004; 18: 1364-66
  15. Staldler H. Le défi de l'enseignement en médecine ambulatoire. Médecine et hygiène 2001; 59: 1848-50
  16. Wilson T, Sheikh A. Enhancing public safety in primary care. B M J 2002; 324: 584-7
  17. M J Kurley R K, Fraser R C, Baker R Model for directly assessing and improving clinical competence and performance in revalidation of clinicians B M J 2001; 322: 712-5
  18. Landon B E, Normand S T, Blumenthal D Physician clinical performance assessment prospects and barriers. JAMA 2003; 290: 1183-89
  19. Roland M. Linking physicisian's pay to the quality of care. A major experiment in the united kingdom N Engl J Med 2004; 351: 1448-54
  20. Rosenthal MB, Frank RG, Li Z et al. Early experience with pay for performance from concept to practice JAMA 2005; 294:1788-93
  21. Deveugele M, Derese Aet al. Consultation length in general practice: cross sectional study BMJ 2002; 325: 472-4
  22. Bindman A, Forrest C, Britt H et al. Diagnostic scope and exposure to primary care physicians in Australia, New Zealand and the United States: Cross Sectional Analysis of results from three national surveys BMJ 2007; 334: 1261-4
  23. Langewitz W, Denz M, Feller A et al. Spontaneous talking time at start of consultation in out patient clinic: Cohort study. BMJ 2002; 325: 682-3
  24. Rabinowitz I, Luzzatti R, Tamir A et al. Length of patient's monologue, rate of completion and relation to other components of the clinical encounter. Observational intervention study in primary care BMJ 2004; 328: 501-2
  25. Aubert JP, Coste N, Audran G et al. Stratégies d'interrogatoires sur les antécédents familiaux au cours d'une consultation de médecine générale. La revue du praticien M G 2003; 17 :1044
  26. Chahed MK, Maghazaoua F et al. Médecins généralistes et médecine générale: Image sociale et représentation de la population. La Tunisie médicale 2001 ; 79 : 401-7
  27. Ennigrou S, Ayari H, Skhiri H et al. Médecine générale et médecins généralistes le point de vue des enseignants de la faculté de médecine de Tunis La Tunisie Médicale 2002 ; 80 : 605-15
  28. Bicane Z. Préférences des malades pour l'approche centrée sur le patient dans la consultation de médecine générale. Thèse Médecin Monastir (Tunisie) 2003/1065
  29. Emanuel EJ, Emanuel ll. Four models of the physician patient's relationship. JAMA 1992; 267: 2221-26
  30. Roter DL, Stewart M, Putnam SM et al. Communication patterns of primary care physicians JAMA 1997; 277: 350-56
  31. Diblasi Z, Harkness E, Giorgiou A. Influence of context effects on health outcomes a systematic review. The Lancet 2001; 357: 757-62
  32. Moreau A, Boussageon R, Givier P. Efficacité thérapeutique de l'effet médecin en soins primaires. Presse médicale 2006; 35: 967-73
  33. Canevet JP. Maladies imaginaires et plaintes répétitives en médecine générale. La revue du praticien MG 1998; 12: 425- 23,26
  34. Rig A, Dowick C, Humphis G. Do patients with unexplained physical symptoms pressurise general practionners for somatic treatment? a qualitative study. BMJ 2004; 328: 1057-60
  35. Luthy C, Cedraschi C, De Tonnac N. Symptômes médicalement inexpliqués en médecine interne recommandations pour la prise en charge hospitalière. Med hyg 2003; 61: 918-22
  36. Moreau A, Givier P, Figou S et al. Symptômes biomédicalement inexpliqués: intérêt de l'approche globale en médecine générale. La revue du praticien MG 2004; 18: 292-5
  37. Latrech M.L. et al. Analyse de l'activité d'un CSB : Application de la CISP2. Communication VIII journées de DSSB Tunis 2000 Sept. 1-20
  38. Ben Abdelaziz A. et al. Morbidity diagnosed in the general medicine public structure in Tunisia. Santé Publique 2003; 15: 191-202.
  39. Ben Abdelaziz A. et al. Les motifs de consultation en médecine générale. Tunisie Med. 2003; 81: 926-32
  40. Dexter PR, Perkins S, Overhage JM et al. Acomputerized reminder system to increase the use of preventive care for hospitalized patients N.Engl.J.Med. 2001; 345: 965-70
  41. Kuperman G, Gibson R. Computer physician order entry: benefits, costs and issues. Ann. Intern. Med. 2003; 139: 31-9.
  42. Hippisley-Cox J, Pringle M, Cater R et al. Information in practice. BMJ. 2003; 326: 1439-43.