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Dimitrova V, Stoitsova S, Nenova G, Martinova M, Yakimova M, Rangelova V, Georgieva I, Georgiev I, Krumova S, Minkova A, Vladimirova N, Nikolaeva-Glomb L. Bulgarian General Practitioners' Communication Styles about Child Vaccinations, Mainly Focused on Parental Decision Making in the Context of a Mandatory Immunization Schedule. Healthcare (Basel) 2023; 11:2566. [PMID: 37761763 PMCID: PMC10531209 DOI: 10.3390/healthcare11182566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
The communication practices of general practitioners in relation with vaccines have not been a topic of wide scientific interest. In this article, we outline them in the context of Bulgaria. A representative, cross-sectional, quantitative, face-to-face survey was conducted among 358 Bulgarian general practitioners in 2022 using simple random sampling. We conducted an exploratory factor analysis using questions about the role of the GPs, which measure models of communication. Based on the factor analysis, we distinguished four communication styles. They were called: active communicator, restrictive communicator, informing communicator, and strained communicator. One-way ANOVA and the T-test were carried out to explore the connections between factor scores (communication styles) and other variables. One of the most important results in the study was that the informing physician (emphasizing the choice of the parents) was the most common model in Bulgaria. This is somewhat contradictory, because of the mandatory status of most vaccines. We found connections between the communication styles and other variables-such as the type of settlement, having a hesitant parent in the practice, recommendations of non-mandatory vaccines, and experience with vaccine-preventable diseases. On the basis of the factor analysis and analysis of relationships with other variables, we reached the conclusion that in Bulgaria, hesitant parents are not sufficiently involved in active, effective communication about vaccines by GPs.
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Affiliation(s)
- Veronika Dimitrova
- Department of Sociology, Sofia University, 1000 Sofia, Bulgaria; (G.N.); (M.Y.)
| | - Savina Stoitsova
- Department of Epidemiology, National Centre of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria; (S.S.); (I.G.); (A.M.); (N.V.)
| | - Gergana Nenova
- Department of Sociology, Sofia University, 1000 Sofia, Bulgaria; (G.N.); (M.Y.)
| | - Maria Martinova
- Communities and Identities Department, Institute of Sociology and Philosophy at the Bulgarian Academy of Sciences, 1000 Sofia, Bulgaria;
| | - Milena Yakimova
- Department of Sociology, Sofia University, 1000 Sofia, Bulgaria; (G.N.); (M.Y.)
| | - Vanya Rangelova
- Department of Epidemiology and Disaster Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
| | - Irina Georgieva
- Department of Virology, National Centre of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria; (I.G.); (S.K.); (L.N.-G.)
| | - Ivo Georgiev
- Department of Epidemiology, National Centre of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria; (S.S.); (I.G.); (A.M.); (N.V.)
| | - Stefka Krumova
- Department of Virology, National Centre of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria; (I.G.); (S.K.); (L.N.-G.)
| | - Antoaneta Minkova
- Department of Epidemiology, National Centre of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria; (S.S.); (I.G.); (A.M.); (N.V.)
| | - Nadezhda Vladimirova
- Department of Epidemiology, National Centre of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria; (S.S.); (I.G.); (A.M.); (N.V.)
| | - Lubomira Nikolaeva-Glomb
- Department of Virology, National Centre of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria; (I.G.); (S.K.); (L.N.-G.)
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Gilardi L, Marconcini M, Metz-Marconcini A, Esch T, Erbertseder T. Long-term exposure and health risk assessment from air pollution: impact of regional scale mobility. Int J Health Geogr 2023; 22:11. [PMID: 37208713 PMCID: PMC10196305 DOI: 10.1186/s12942-023-00333-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/08/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND The negative effect of air pollution on human health is widely reported in recent literature. It typically involves urbanized areas where the population is concentrated and where most primary air pollutants are produced. A comprehensive health risk assessment is therefore of strategic importance for health authorities. METHODS In this study we propose a methodology to perform an indirect and retrospective health risk assessment of all-cause mortality associated with long-term exposure to particulate matter less than 2.5 microns (PM2.5), nitrogen dioxide (NO2) and ozone (O3) in a typical Monday to Friday working week. A combination of satellite-based settlement data, model-based air pollution data, land use, demographics and regional scale mobility, allowed to examine the effect of population mobility and pollutants daily variations on the health risk. A Health Risk Increase (HRI) metric was derived on the basis of three components: hazard, exposure and vulnerability, utilizing the relative risk values from the World Health Organization. An additional metric, the Health Burden (HB) was formulated, which accounts for the total number of people exposed to a certain risk level. RESULTS The effect of regional mobility patterns on the HRI metric was assessed, resulting in an increased HRI associated with all three stressors when considering a dynamic population compared to a static one. The effect of diurnal variation of pollutants was only observed for NO2 and O3. For both, the HRI metric resulted in significantly higher values during night. Concerning the HB parameter, we identified the commuting flows of the population as the main driver in the resulting metric. CONCLUSIONS This indirect exposure assessment methodology provides tools to support policy makers and health authorities in planning intervention and mitigation measures. The study was carried out in Lombardy, Italy, one of the most polluted regions in Europe, but the incorporation of satellite data makes our approach valuable for studying global health.
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Affiliation(s)
- Lorenza Gilardi
- German Remote Sensing Data Center, Department Atmosphere (DFD-ATM), German Aerospace Center (DLR), Münchener Str. 20, 82234, Weßling, Germany.
| | - Mattia Marconcini
- German Remote Sensing Data Center, Department Land Surface Dynamics (DFD-LAX), German Aerospace Center (DLR), Münchener Str. 20, 82234, Weßling, Germany
| | - Annekatrin Metz-Marconcini
- German Remote Sensing Data Center, Department Land Surface Dynamics (DFD-LAX), German Aerospace Center (DLR), Münchener Str. 20, 82234, Weßling, Germany
| | - Thomas Esch
- German Remote Sensing Data Center, Department Land Surface Dynamics (DFD-LAX), German Aerospace Center (DLR), Münchener Str. 20, 82234, Weßling, Germany
| | - Thilo Erbertseder
- German Remote Sensing Data Center, Department Atmosphere (DFD-ATM), German Aerospace Center (DLR), Münchener Str. 20, 82234, Weßling, Germany
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Singier A, Carrier H, Tournier M, Pariente A, Verger P, Salvo F. General practitioners' compliance with benzodiazepine discontinuation guidelines in patients treated with long-term lorazepam: A case-vignette cross-sectional survey. Therapie 2021; 77:349-359. [PMID: 34600759 DOI: 10.1016/j.therap.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/26/2021] [Accepted: 09/03/2021] [Indexed: 11/30/2022]
Abstract
AIM To study determinants associated with GPs' compliance with benzodiazepine discontinuation guidelines through a case-vignette of a patient with multimorbidity treated with long-term lorazepam for insomnia. METHODS This cross-sectional survey was performed in a sample of French GPs. The questionnaire included items on their characteristics and questions related to the management of a case-vignette with long-term lorazepam use consulting for a prescription renewal. GPs who proposed a dedicated consultation to discuss discontinuation or progressive discontinuation were considered as "following guidelines", while they were considered as "out-of-guidelines" if they proposed immediate discontinuation or decided not to discontinue lorazepam. A backward selection process was used to select factors to be included in the final logistic regression model. The probabilities of out-of-guidelines practice and their 95% confidence interval (95% CI) were then plotted using a heatmap graph. RESULTS Of 1,177 GPs, the majority (92.2%) were aware of the necessity to discontinue lorazepam and reported practice consistent with good practice guidelines. Women GPs aged under 50 years had the lowest estimated probability of out-of-guidelines practice. Conversely, men aged over 58 years with high consideration of patient preferences and low concern about the benefit-risk ratio of lorazepam had the highest probability of out-of-guidelines practice (27.3% [18.7%; 34.7%]). CONCLUSION GPs largely reported practice compliant with benzodiazepine discontinuation guidelines, although some GPs, mainly older men who overemphasise patient preferences, were more likely to adopt out-of-guidelines practice.
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Affiliation(s)
| | - Hélène Carrier
- Aix-Marseille Univ, Department of General Practice, 13000 Marseille, France; Aix-Marseille Univ, IRD (Research Institute for Development), AP-HM (Hospitals of Marseille), SSA (Army Health Services), VITROME, 13000 Marseille, France
| | - Marie Tournier
- Univ. Bordeaux, INSERM, BPH, U1219, 33000 Bordeaux, France; Hospital Charles Perrens, 33000 Bordeaux, France
| | - Antoine Pariente
- Univ. Bordeaux, INSERM, BPH, U1219, 33000 Bordeaux, France; CHU de Bordeaux, Pôle de Santé publique, Service de pharmacologie médicale, 33000 Bordeaux, France
| | - Pierre Verger
- Aix-Marseille Univ, IRD (Research Institute for Development), AP-HM (Hospitals of Marseille), SSA (Army Health Services), VITROME, 13000 Marseille, France; ORS PACA, Regional Health Observatory, 13000 Marseille, France
| | - Francesco Salvo
- Univ. Bordeaux, INSERM, BPH, U1219, 33000 Bordeaux, France; CHU de Bordeaux, Pôle de Santé publique, Service de pharmacologie médicale, 33000 Bordeaux, France.
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Oduwole EO, Mahomed H, Ayele BT, Wiysonge CS. Estimating vaccine confidence levels among healthcare students and staff of a tertiary institution in South Africa: protocol of a cross-sectional survey. BMJ Open 2021; 11:e049877. [PMID: 33986069 PMCID: PMC8126322 DOI: 10.1136/bmjopen-2021-049877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The outbreak of novel COVID-19 caught the world off guard in the first quarter of 2020. To stem the tide of this pandemic, there was acceleration of the development, testing and prelicensure approval for emergency use of some COVID-19 vaccine candidates. This led to raised public concern about their safety and efficacy, compounding the challenges of vaccine hesitancy. The onus of managing and administering these vaccines to a sceptical populace when they do become available rests mostly on the shoulders of healthcare workers (HCWs). Therefore, the vaccine confidence levels of HCWs become critical to the success of vaccination endeavours. This proposed study aims to estimate the level of vaccine confidence and the intention to receive a COVID-19 vaccine among future HCWs and their trainers at a specific university in Cape Town, South Africa, and to identify any vaccination concerns early for targeted intervention. METHODS AND ANALYSIS This proposed study is a cross-sectional survey study. An online questionnaire will be distributed to all current staff and students of the Faculty of Medicine Health Sciences of Stellenbosch University in Cape Town, South Africa. No sampling strategy will be employed. The survey questionnaire will consist of demographic questions (consisting of six items) and vaccine confidence questions (comprising six items in Likert scale format). Log binomial models will be employed to identify factors associated with vaccine confidence and intention. The strength of association will be assessed using the OR and its 95% CI. Statistical significance will be defined at a p value <0.05. ETHICS AND DISSEMINATION Ethics approval has been obtained for the study from Stellenbosch University (Human Research Ethics Committee reference number S19/01/014 (PhD)). The results will be shared with relevant health authorities, presented at conferences and published in a peer-reviewed journal.
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Affiliation(s)
- Elizabeth O Oduwole
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Hassan Mahomed
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Birhanu T Ayele
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Charles Shey Wiysonge
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
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Attinsounon CA, Cordonnier C, Pulcini C, Di-Patrizio P, Thilly N, May T. Factors associated with influenza vaccination of general medicine interns in Nancy, France, in 2017. Eur J Clin Microbiol Infect Dis 2019; 38:2267-2273. [PMID: 31410622 DOI: 10.1007/s10096-019-03669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
Winter flu is an epidemic infectious disease which sometimes causes serious complications in vulnerable people treated in general practice. Currently, the most effective means of prevention is influenza vaccination, which is recommended for healthcare professionals, including general medicine interns. The target of 75% coverage set by WHO for healthcare professional is rarely reached. Our survey provides an assessment of reported influenza vaccination of general medicine interns (GMI) and evaluates factors influencing their vaccination status. A cross-sectional survey was conducted from 27 September to 2 November 2017 in the Faculty of Medicine at the University of Lorraine in France. An anonymous self-administered questionnaire was distributed electronically (SurveyMonkey software) to all GMI. It collected data on their vaccination status and on levers and barriers to influenza vaccination. The data were analysed using SAS 9.4 software. Multivariate analysis helped identify factors associated with their influenza vaccination status. Of the 595 GMI invited, 269 participated in the survey, with a response rate of 45.2%. During the 2015, 2016, and 2017 winters, overall self-declared vaccine coverage was 37.9, 49.4, and 56.5%, respectively. Being at the end of training (p = 0.008, OR = 3.2), the presence of a mobile vaccination team (p = 0.019, OR = 3.1), and recommending vaccination to one's relatives and friends (p < 0.0001, OR = 5.4) were the three factors independently associated with influenza vaccination. The two main reasons which had a strong influence on non-vaccination were forgetting to do so (30.5%) and lack of time (24.8%). Influenza vaccination coverage of GMI in Nancy falls well short of WHO targets. Vaccination campaigns and facilitated access to vaccination at study and work placement locations should be considered.
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Affiliation(s)
- Cossi Angelo Attinsounon
- Faculté de Médecine, CHUD-Borgou, Unité d'Enseignement et de Recherche en Maladies Infectieuses et Tropicales, Université de Parakou, 03 BP 112, Parakou, Benin. .,CHRU-Nancy, Service des Maladies Infectieuses et Tropicales, Université de Lorraine, 54000, Nancy, France.
| | - Clémence Cordonnier
- Département de Médecine Générale, Université de Lorraine, 54000, Nancy, France
| | - Céline Pulcini
- CHRU-Nancy, Service des Maladies Infectieuses et Tropicales, Université de Lorraine, 54000, Nancy, France.,APEMAC, Université de Lorraine, F-54000, Nancy, France
| | - Paolo Di-Patrizio
- Département de Médecine Générale, Université de Lorraine, 54000, Nancy, France
| | - Nathalie Thilly
- APEMAC, Université de Lorraine, F-54000, Nancy, France.,CHRU-Nancy, Plateforme d'Aide à la Recherche Clinique, Université de Lorraine, F-54000, Nancy, France
| | - Thierry May
- CHRU-Nancy, Service des Maladies Infectieuses et Tropicales, Université de Lorraine, 54000, Nancy, France.,APEMAC, Université de Lorraine, F-54000, Nancy, France
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Collange F, Zaytseva A, Pulcini C, Bocquier A, Verger P. Unexplained variations in general practitioners' perceptions and practices regarding vaccination in France. Eur J Public Health 2019; 29:2-8. [PMID: 30085024 DOI: 10.1093/eurpub/cky146] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Given geographical disparities in vaccination coverage (VC) and the crucial role general practitioners (GPs) play in vaccination in France, we sought to: 1) determine the existence of geographical variations in GPs' perceptions of vaccines, their trust in information sources, and the frequency of their recommendations to patients by comparing data from southeast (SE), central-west (CW), northwest (NW), and the rest of France; and 2) identify individual and contextual factors associated with regional variations in GPs' recommendations. Methods This cross-sectional observational study in 2014 collected data from a panel of 2586 French GPs in private practice: 3 specific regional samples and a fourth sample for the rest of France. We calculated a composite score summarizing GPs' vaccine recommendation frequency for 6 vaccine situations and used a five-step hierarchical linear regression to study the score's links with practice location and individual and contextual factors. Results GPs' vaccine recommendation frequency score was highest in NW France and lowest in the SE. The low SE score was explained by GPs' greater doubts about vaccine utility and risks and lower trust in information sources. The high NW score was partially explained by greater adherence to guidelines by GPs there. The contextual factors studied did not explain regional differences. Conclusion The geographical variations in GPs' vaccination-related attitudes and practices suggest that vaccine hesitancy among GPs differs in prevalence between regions. These variations coincide with north/south trends in population VC. Intervention strategies to restore confidence in vaccines should target GPs and must be adapted to each regional context.
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Affiliation(s)
- Fanny Collange
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France.,Southeastern Health Regional Observatory, ORS PACA, Marseille, France
| | - Anna Zaytseva
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France.,Southeastern Health Regional Observatory, ORS PACA, Marseille, France
| | - Céline Pulcini
- Université de Lorraine, EA 4360 APEMAC and, CHRU de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France
| | - Aurélie Bocquier
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France.,Southeastern Health Regional Observatory, ORS PACA, Marseille, France
| | - Pierre Verger
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France.,Southeastern Health Regional Observatory, ORS PACA, Marseille, France
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GPs' management of polypharmacy and therapeutic dilemma in patients with multimorbidity: a cross-sectional survey of GPs in France. Br J Gen Pract 2019; 69:e270-e278. [PMID: 30803978 DOI: 10.3399/bjgp19x701801] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 07/17/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND GPs are confronted with therapeutic dilemmas in treating patients with multimorbidity and/or polypharmacy when unfavourable medication risk-benefit ratios (RBRs) conflict with patients' demands. AIM To understand GPs' attitudes about prescribing and/or deprescribing medicines for patients with multimorbidity and/or polypharmacy, and factors associated with their decisions. DESIGN AND SETTING Cross-sectional survey in 2016 among a national panel of 1266 randomly selected GPs in private practice in France. METHOD GPs' opinions and attitudes were explored using a standardised questionnaire including a case vignette about a female treated for multiple somatic diseases, sleeping disorders, and chronic pain. Participants were randomly assigned one of eight versions of this case vignette, varying by patient age, socioprofessional status, and stroke history. Backward selection was used to identify factors associated with GPs' decisions about drugs they considered inappropriate. RESULTS Nearly all (91.4%) responders felt comfortable or fairly comfortable deprescribing inappropriate medications, but only 34.7% decided to do so often or very often. In the clinical vignette, most GPs chose to discontinue symptomatic medications (for example, benzodiazepine, paracetamol/tramadol) because of unfavourable RBRs. When patients asked for ketoprofen for persistent sciatica, 94.1% considered this prescription risky, but 25.6% would prescribe it. They were less likely to prescribe it to older patients (adjusted odds ratio [AOR] 0.48, 95% confidence interval [CI] = 0.36 to 0.63), or those with a stroke history (AOR 0.55, 95% CI = 0.42 to 0.72). CONCLUSION In therapeutic dilemmas, some GPs choose to prioritise patients' requests over iatrogenic risks. GPs need pragmatic implementation tools for handling therapeutic dilemmas, and to improve their skills in medication management and patient engagement in such situations.
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Silhol J, Ventelou B, Zaytseva A, Marbot C. Comportements et pratiques des médecins : exercer dans les zones les moins dotées, cela fait-il une différence ? ACTA ACUST UNITED AC 2019. [DOI: 10.3917/rfas.192.0213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Costa M, Yaya I, Mora M, Marcellin F, Villotitch A, Berenger C, Tanti M, Cutarella C, Polomeni P, Maradan G, Roux P, Rolland B, Carrieri PM. Barriers and levers in screening and care for alcohol use disorders among French general practitioners: results from a computer-assisted telephone interview-based survey. ALCOHOLISM TREATMENT QUARTERLY 2018. [DOI: 10.1080/07347324.2018.1514989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Marie Costa
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Issifou Yaya
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Marion Mora
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Fabienne Marcellin
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Antoine Villotitch
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Cyril Berenger
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Marc Tanti
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Centre d’Epidémiologie et de Santé Publique des Armées, Marseille, France
| | | | | | - Gwenaelle Maradan
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Perrine Roux
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Benjamin Rolland
- Service Universitaire d’Addictologie, Bron, France
- Centre de Recherche en Neurosciences de Lyon, Institut national de la santé et de la recherche médical U1028, Centre national de la recherche scientifique UMR5292, Univ Lyon, Université Claude Bernard Lyon 1, France
| | - Patrizia Maria Carrieri
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Université, INSERM (Institut National de la Santé et de la Recherche Médicale), IRD (Institut de la recherche pour le développement), SESSTIM (Sciences économiques et Sociales de la Santé, Traitem, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
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Raffetin A, Ortmans C, Worms B, Cadwallader JS. French guidelines for the outpatient management of Ebola virus disease: Applicability by family physicians. Med Mal Infect 2018; 48:526-532. [PMID: 30197019 DOI: 10.1016/j.medmal.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 12/04/2017] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND During the last alarming Ebola Virus Disease (EVD) outbreak, the French Ministry of Health developed guidelines for the outpatient management of EVD. We aimed to assess family physicians' (FP) knowledge of EVD, to assess their working conditions, and to collect their opinion about the applicability of these guidelines in France. METHODS Cross-sectional quantitative study (telephone or email) performed (November 2014-June 2015) during the EVD outbreak. Relevant results were further analyzed with a qualitative study (interviews) based on grounded theory (June-September 2016), after the end of the EVD outbreak. RESULTS Thirty-three FPs out of 100contacted answered our survey (response rate: 33%). We interviewed five FPs. Their knowledge of EVD was good. Information sent by post, especially from the national medical association, was considered the best means of information and was preferred to emails. Compliance with guidelines was based on their ease of understanding and application (common sense). The main difficulty in applying these guidelines was the unusual recommended equipment that seemed unnecessary as the management of these patients was based on their interview (anamnesis) and isolation without examination. EVD had little impact on the FPs' practice, they only trained their secretaries to screen for suspected EVD patients and refer them to the mobile emergency unit. CONCLUSION FPs had good knowledge of EVD and guidelines. This seemed important to prevent the outbreak in France as they were ready to cope with such a situation, thanks to guidelines they could easily adjust to their practice.
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Affiliation(s)
- A Raffetin
- Service de maladies infectieuses et tropicales, CHI Villeneuve Saint-Georges, , 20, allée de la Source, 94190 Villeneuve-Saint-Georges, France; Département de médecine générale, faculté de médecine, université Pierre-et-Marie-Curie, Paris 6, site Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
| | - C Ortmans
- Direction générale de la santé, bureau de veille et de sécurité sanitaire et de gestion des risques infectieux, 14, avenue Duquesne, 75007 Paris, France
| | - B Worms
- Direction générale de la santé, bureau de veille et de sécurité sanitaire et de gestion des risques infectieux, 14, avenue Duquesne, 75007 Paris, France
| | - J-S Cadwallader
- Département de médecine générale, faculté de médecine, université Pierre-et-Marie-Curie, Paris 6, site Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
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11
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Janah A, Rey D, Bouhnik AD, Mancini J, Sarradon-Eck A, Verger P, Peretti-Watel P, Bendiane MK. Opioid Analgesics Prescription to End-of-Life Cancer Patients: Characteristics, Attitudes, and Practices of French General Practitioners. J Palliat Med 2018; 21:1741-1748. [PMID: 30183469 DOI: 10.1089/jpm.2018.0222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Pain management, especially at the end of life, varies depending on the prescriber's characteristics and attitudes. Little is known about the practices of general practitioners (GPs) regarding end-of-life management for patients with cancer. Objectives: To provide an overview of the characteristics associated with GPs' attitudes and practices regarding opioids prescribing and to explore GPs' perceived role and difficulties in managing end-of-life care for patients with cancer. Design: A cross-sectional study (December 2015 to March 2016). Subjects and Analyses: Data were collected from a representative sample of 376 GPs in southeastern France recruited to participate in a survey on medical practices and opinions regarding cancer patient management. Descriptive analyses and multivariate logistic regressions were conducted to study the characteristics, attitudes, and practices associated with GPs' opioids prescribing attitudes. Results: Almost 97% of GPs stated that they prescribe opioids to end-of-life cancer patients. Among these, 77% said that they prescribe opioids on their own initiative, while 23% declared doing so in coordination with a specialist team. Female GPs, GPs working in solo practices, and GPs reporting more difficulties in managing end-of-life cancer patients were significantly less likely to prescribe opioids on their own initiative. Conclusion: Our results suggest that GPs' characteristics and practices influence the prescribing attitudes at the end of life. Given the dearth of studies on this topic, further research is recommended to better understand the impact of GPs' characteristics on their prescriptive attitudes. The possible interactions between patients' and physicians' characteristics-in particular gender-should also be investigated.
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Affiliation(s)
- Asmaa Janah
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France
| | - Dominique Rey
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Anne-Déborah Bouhnik
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France
| | - Julien Mancini
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France.,BiosTIC, La Timone Hospital, APHM, Marseille, France
| | - Aline Sarradon-Eck
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France.,Inst Paoli Calmettes, SESSTIM, Marseille, France
| | - Pierre Verger
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Patrick Peretti-Watel
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
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12
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The practices of French general practitioners regarding screening and counselling pregnant women for tobacco smoking and alcohol drinking. Int J Public Health 2018; 63:631-640. [PMID: 29679105 DOI: 10.1007/s00038-018-1103-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 03/02/2018] [Accepted: 04/06/2018] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES Our study aims to describe French general practitioners' (GPs') practices toward pregnant patients regarding alcohol consumption and smoking and to highlight factors associated with specific practices. METHODS In 2015, a representative sample of 1414 French GPs completed a telephone survey based on a stratified random sampling. RESULTS 61% of GPs declared screening for alcohol use and 82% for smoking at least once with each pregnant patient; quitting was not systematically advised either for alcohol or for smoking. GPs' practices were significantly better among those who had more recent ongoing training. GPs who drank regularly were less likely to screen for alcohol use and GPs' drinking frequency was inversely related to recommending quitting. Current and former smokers were less likely to recommend quitting to pregnant patients smoking over five cigarettes per day. CONCLUSIONS Screening and counselling practices for substance use during pregnancy are heterogeneous among French GPs and are notably related to their personal consumption. GP's role in preventing substance use during pregnancy could be strengthened by actions regarding their own consumption and by modifications in their initial and ongoing training.
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13
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Le Marechal M, Fressard L, Agrinier N, Verger P, Pulcini C. General practitioners' perceptions of vaccination controversies: a French nationwide cross-sectional study. Clin Microbiol Infect 2017; 24:858-864. [PMID: 29104170 DOI: 10.1016/j.cmi.2017.10.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 10/12/2017] [Accepted: 10/28/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVES We aimed to study general practitioners' (GPs') perceptions of vaccines that have been a subject of controversy in France. METHODS A cross-sectional survey in 2014 asked a representative national sample of GPs, randomly selected from the exhaustive database of health professionals in France, about their perceptions of the likelihood of serious adverse events potentially associated with six different vaccines: for two of them the association was based on some scientific evidence, whereas for the other four this is not the case. We performed a cluster analysis to construct a typology of GPs' perceptions about the likelihood of these potential six associations. Factors associated with certain clusters of interest were identified using logistic regression models. RESULTS Overall, 1582 GPs participated in the questionnaire survey (1582/1712 GPs who agreed to participate, 92%). Cluster analysis identified four groups of GPs according to their susceptibility to vaccine controversies: 1) limited susceptibility to controversies (52%); 2) overall unsure, but rejected the association between hepatitis B vaccine and multiple sclerosis (32%); 3) highly susceptible to controversies (11%); and 4) unsure (5%). We found that GPs who occasionally practised alternative medicine (OR 2.71, 95% CI 1.65-4.45), and those who considered information provided by mass media as reliable (OR 2.04, 95% CI 1.65-3.99) were more susceptible to controversies. CONCLUSIONS GPs had different profiles of susceptibility to vaccination controversies, and most of their perceptions of these controversies were not based on scientific evidence.
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Affiliation(s)
- M Le Marechal
- Université de Lorraine, EA 4360 APEMAC, Nancy, France
| | - L Fressard
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - N Agrinier
- Université de Lorraine, EA 4360 APEMAC, Nancy, France; INSERM, CIC-1433 Epidémiologie clinique, CHRU de Nancy, Nancy, France
| | - P Verger
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France; INSERM, F-CRIN, I-Reivac (Innovative clinical research network in vaccinology), France
| | - C Pulcini
- Université de Lorraine, EA 4360 APEMAC, Nancy, France; Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France; CHRU de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France.
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14
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Le Maréchal M, Fressard L, Raude J, Verger P, Pulcini C. General practitioners and vaccination of children presenting with a benign infection. Med Mal Infect 2017; 48:44-52. [PMID: 29113691 DOI: 10.1016/j.medmal.2017.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the self-reported vaccination behavior of general practitioners (GPs) when asked whether they would recommend the vaccination of a child presenting with a febrile uncomplicated common cold. METHODS We performed a cross-sectional survey in 2014 on a national sample of GPs. GPs were randomly assigned to one of eight clinical vignettes, all describing a child presenting with an uncomplicated febrile common cold, but differing by age (4 or 11 months), temperature (38°C or 39°C), and the mother's emotional state (calm or worried). GPs were asked whether they would recommend immediate vaccination of the child with a hexavalent vaccine (diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b, and hepatitis B), or postpone it. We investigated the relation between the GPs' recommendation to vaccinate, the clinical vignette's variables, and the GPs' perceptions, attitudes, and practices toward vaccination in a multivariate model. RESULTS Among the 1582 participating GPs, 6% recommended immediate vaccination. This behavior was more frequent with a temperature of 38°C rather than 39°C (10% vs. 3%, P<0.001). GPs who felt comfortable giving explanations about vaccine safety were more likely to recommend immediate vaccination of the febrile child (P=0.045), but none of the other GPs' characteristics were associated with their vaccination behavior. CONCLUSIONS Almost all GPs postponed the hexavalent vaccination of the febrile child presenting with an uncomplicated viral disease; fever being the major factor affecting their decision. More research is needed on vaccination responses in sick children, as well as clearer guidelines.
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Affiliation(s)
- M Le Maréchal
- Université de Lorraine, EA 4360 APEMAC, 54000 Nancy, France.
| | - L Fressard
- Aix-Marseille université, UMR_S912, IRD, 13000 Marseille, France; Observatoire régional de la santé Provence-Alpes-Côte d'Azur (ORS PACA), 13000 Marseille, France; Inserm, UMR_S912, « Sciences Économiques & Sociales de la Santé et Traitement de l'Information Médicale » (SESSTIM), 13000 Marseille, France
| | - J Raude
- EHESP-Rennes, Sorbonne-Paris-Cité, 35043 Rennes, France; Aix-Marseille université, EPV-UMR_D 190 « Émergence des Pathologies Virales », 13000 Marseille, France
| | - P Verger
- Aix-Marseille université, UMR_S912, IRD, 13000 Marseille, France; Observatoire régional de la santé Provence-Alpes-Côte d'Azur (ORS PACA), 13000 Marseille, France; Inserm, UMR_S912, « Sciences Économiques & Sociales de la Santé et Traitement de l'Information Médicale » (SESSTIM), 13000 Marseille, France; Inserm, F-CRIN, I-Reivac (Innovative clinical research network in vaccinology), 75654 Paris, France
| | - C Pulcini
- Université de Lorraine, EA 4360 APEMAC, 54000 Nancy, France; Inserm, F-CRIN, I-Reivac (Innovative clinical research network in vaccinology), 75654 Paris, France; Service de maladies infectieuses et tropicales, CHRU de Nancy, 54000 Nancy, France
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15
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Low Uptake of Meningococcal C Vaccination in France: A Cross-sectional Nationwide Survey of General Practitioners' Perceptions, Attitudes and Practices. Pediatr Infect Dis J 2017; 36:e181-e188. [PMID: 28178106 DOI: 10.1097/inf.0000000000001553] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Meningococcal C glycoconjugate vaccine (MenCV) has been recommended in France since 2010, but its uptake remains low (64% coverage among 2-year-olds in 2014). Because general practitioners (GPs) are the cornerstone of the French vaccination program, we sought to assess their perceptions, attitudes, practices and recommendations to patients for this vaccine. METHODS A cross-sectional survey in 2014 asked a national sample of 1582 GPs if they would recommend MenCV for patients 12 months of age (routine vaccination) and 2-24 years of age (catch-up vaccination) and explored the barriers to vaccination. RESULTS Overall, 52% of GPs (800/1547) reported they always recommend routine MenCV vaccination and 33% (523/1572), catch-up vaccination. The most frequently reported barriers to vaccination were that parents have never heard of this vaccine (72%, 1094/1523), underestimate the risk of contracting meningococcal disease (69%, 1049/1514) and are unaware of its seriousness (55%, 838/1537). In multivariate analyses, GPs recommended routine and catch-up vaccination significantly more often when they had no doubt about the utility and safety of this vaccine, when they thought that the official MenCV recommendation was clear and when their own children were vaccinated. GPs who reported that their patients either were unaware of the severity of bacterial meningitis (P = 0.012) or had no doubts about the efficacy of MenCV recommended catch-up vaccination more often (P = 0.015). CONCLUSIONS GPs did not appear to recommend MenCV often enough. Our results suggest that clearer recommendations and a better communications campaign directed at patients and healthcare workers could be useful.
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16
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Discrepancies between general practitioners' vaccination recommendations for their patients and practices for their children. Clin Microbiol Infect 2017; 23:311-317. [DOI: 10.1016/j.cmi.2016.08.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 08/13/2016] [Accepted: 08/14/2016] [Indexed: 11/17/2022]
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17
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Verger P, Collange F, Fressard L, Bocquier A, Gautier A, Pulcini C, Raude J, Peretti-Watel P. Prevalence and correlates of vaccine hesitancy among general practitioners: a cross-sectional telephone survey in France, April to July 2014. ACTA ACUST UNITED AC 2017; 21:30406. [PMID: 27918262 PMCID: PMC5291145 DOI: 10.2807/1560-7917.es.2016.21.47.30406] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 07/11/2016] [Indexed: 01/21/2023]
Abstract
This article sought to estimate the prevalence of vaccine hesitancy (VH) among French general practitioners (GPs) and to study its demographic, professional and personal correlates. We conducted a cross-sectional telephone survey about GPs' vaccination-related attitudes and practices in 2014 in a national panel of 1,712 GPs in private practice, randomly selected from an exhaustive database of health professionals in France. A cluster analysis of various dimensions of VH (self-reported vaccine recommendations, perceptions of vaccine risks and usefulness) identified three clusters: 86% of GPs (95% confidence interval (CI): 84-88) were not or only slightly vaccine-hesitant, 11% (95% CI: 9-12) moderately hesitant and 3% (95% CI: 3-4) highly hesitant or opposed to vaccination. GPs in the latter two clusters were less frequently vaccinated and reported occasional practice of alternative medicine more often than those in the first cluster; they also described less experience with vaccine-preventable diseases and more experience with patients who they considered had serious adverse effects from vaccination. This study confirms the presence of VH among French GPs but also suggests that its prevalence is moderate. Given GPs' central role in vaccination, these results nevertheless call for a mobilisation of stakeholders to address VH among GPs.
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Affiliation(s)
- Pierre Verger
- INSERM, UMR912 'Economics and Social Sciences Applied to Health and Analysis of Medical Information' (SESSTIM), Marseille, France.,ORS PACA, South-eastern Health Regional Observatory, Marseille, France.,Aix Marseille Université, UMR_S 912, IRD, Marseille, France.,INSERM, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), GH Cochin Broca Hôtel Dieu, Paris, France
| | - Fanny Collange
- INSERM, UMR912 'Economics and Social Sciences Applied to Health and Analysis of Medical Information' (SESSTIM), Marseille, France.,ORS PACA, South-eastern Health Regional Observatory, Marseille, France.,Aix Marseille University, URMITE, IRD 198, UMR CNRS 7278, INSERM 1095, Faculté de Médecine, Marseille, France
| | - Lisa Fressard
- INSERM, UMR912 'Economics and Social Sciences Applied to Health and Analysis of Medical Information' (SESSTIM), Marseille, France.,ORS PACA, South-eastern Health Regional Observatory, Marseille, France.,Aix Marseille Université, UMR_S 912, IRD, Marseille, France
| | - Aurélie Bocquier
- INSERM, UMR912 'Economics and Social Sciences Applied to Health and Analysis of Medical Information' (SESSTIM), Marseille, France.,ORS PACA, South-eastern Health Regional Observatory, Marseille, France.,Aix Marseille Université, UMR_S 912, IRD, Marseille, France
| | - Arnaud Gautier
- Santé publique France (the French national public health agency), Saint-Maurice, France
| | - Céline Pulcini
- CHU de Nancy, Service de Maladies Infectieuses et Tropicales, Hôpitaux de Brabois, Vandœuvre-lès-Nancy, France.,Lorraine University, Paris Descartes University, EA 4360 Apemac, Vandœuvre-lès-Nancy, France
| | - Jocelyn Raude
- EHESP, Sorbonne Paris Cité, Rennes, France.,Aix-Marseille University, IRD French Institute of Research for Development, EHESP, UMR_D 190 'Emergence des Pathologies Virales', Marseille, France
| | - Patrick Peretti-Watel
- INSERM, UMR912 'Economics and Social Sciences Applied to Health and Analysis of Medical Information' (SESSTIM), Marseille, France.,ORS PACA, South-eastern Health Regional Observatory, Marseille, France.,Aix Marseille Université, UMR_S 912, IRD, Marseille, France
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18
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Raude J, Fressard L, Gautier A, Pulcini C, Peretti-Watel P, Verger P. Opening the 'Vaccine Hesitancy' black box: how trust in institutions affects French GPs' vaccination practices. Expert Rev Vaccines 2016; 15:937-48. [PMID: 27140417 DOI: 10.1080/14760584.2016.1184092] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND In recent years, vaccine hesitancy among health professionals has emerged as an important issue on public health agendas. However, we do not yet know very much about whether, and if so how, trust in institutions affects their practices. METHODS A path analysis model explaining the influence of trust on GPs' vaccine hesitancy was applied to a cross-sectional survey of 1,582 French GPs performed in 2014. We hypothesized that distrust in public health institutions influences GPs' concerns about the safety of various vaccines, their perceptions about the importance of vaccination, their self-efficacy in the doctor-patient relationship, and ultimately their vaccination recommendations to patients. RESULTS GPs' trust in institutions was found to be significantly associated with lower vaccine hesitancy, an association mediated to a large extent by the vaccine's perceived safety (β = 0.09, P < 0.01) and the importance of vaccination (β = 0.46, P < 0.001). CONCLUSION These results suggest that restoration of high vaccination coverage may require the re-establishment of a significant degree of trust in the public health system among health professionals.
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Affiliation(s)
- Jocelyn Raude
- a IRD French Institute of Research for Development, EHESP French School of Public Health, UMR_D 190 'Emergence des Pathologies Virales' , Aix Marseille University , Marseille , France.,b UMR PIMIT, INSERM 1187, CNRS 9192, IRD 249. Plateforme Technologique CYROI , Université de La Réunion , Réunion , France
| | - Lisa Fressard
- c UMR912 'Economics and Social Sciences Applied to Health & Analysis of Medical Information' (SESSTIM) , INSERM , Marseille , France.,d UMR_S912, IRD, 13006, Aix Marseille University , Marseille , France.,e ORS PACA, Southeastern Health Regional Observatory , Marseille , France
| | - Arnaud Gautier
- f French Public Health Agency, Direction de la prévention - promotion de la santé , Saint-Maurice , France
| | - Céline Pulcini
- g Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC , Nancy , France.,h CHU de Nancy, Service de Maladies Infectieuses , Nancy cedex , France
| | - Patrick Peretti-Watel
- c UMR912 'Economics and Social Sciences Applied to Health & Analysis of Medical Information' (SESSTIM) , INSERM , Marseille , France.,d UMR_S912, IRD, 13006, Aix Marseille University , Marseille , France.,e ORS PACA, Southeastern Health Regional Observatory , Marseille , France
| | - Pierre Verger
- c UMR912 'Economics and Social Sciences Applied to Health & Analysis of Medical Information' (SESSTIM) , INSERM , Marseille , France.,d UMR_S912, IRD, 13006, Aix Marseille University , Marseille , France.,e ORS PACA, Southeastern Health Regional Observatory , Marseille , France
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19
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Collange F, Fressard L, Pulcini C, Sebbah R, Peretti-Watel P, Verger P. General practitioners' attitudes and behaviors toward HPV vaccination: A French national survey. Vaccine 2016; 34:762-8. [PMID: 26752063 DOI: 10.1016/j.vaccine.2015.12.054] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/18/2015] [Accepted: 12/23/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE General practitioners (GPs) play a crucial role in human papillomavirus (HPV) vaccine acceptance in France. We sought to study: (1) GPs' perceptions of its risks and efficacy and their recommendation behavior; (2) the relative importance of factors associated with the frequency of their recommendations. METHODS Cross-sectional observational study in 2014 nested in a national panel of 1712 randomly selected GPs in private practice in France (response rate: 92.4%). We used model averaging to analyze the associations of self-reported frequency of GPs' HPV vaccine recommendations with their perception of its risk-benefit balance and their opinions about the utility of vaccines in general. RESULTS Overall, 72% of participants reported frequently recommending HPV vaccination; 60% considered that not enough is known about its risks. The model averaging showed that the factors most associated with infrequent recommendation of this vaccine by GPs were: unfavorable perceptions of its risk-benefit balance (OR=0.13; 95%CI=0.09-0.21; partial R(2)=0.10), a decision not to vaccinate one's own daughter(s) with this vaccine (OR=0.13; 95%CI=0.07-0.24; partial R(2)=0.05), and doubts about vaccine utility in general (OR=0.78; 95%CI=0.71-0.86; partial R(2)=0.03). CONCLUSION Although nearly three-quarters of French GPs frequently recommended the HPV vaccine, our findings indicate that a substantial percentage of them are hesitant about it. Doubts about its risks and efficacy strongly influence their recommendation behavior. More research is warranted to help design and evaluate tailored tools and multicomponent intervention strategies to address physician's hesitancy about this vaccine.
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Affiliation(s)
- Fanny Collange
- Aix Marseille University, URMITE, IRD 198, UMR CNRS 7278, INSERM 1095, Faculté de Médecine, 13005 Marseille, France; INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 13006 Marseille, France
| | - Lisa Fressard
- INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 13006 Marseille, France; Aix-Marseille University, IRD, UMR-S912, 13006 Marseille, France
| | - Céline Pulcini
- CHU de Nancy, Service de Maladies Infectieuses et Tropicales, Hôpitaux de Brabois, 54511 Vandœuvre-lès-Nancy cedex, France; Lorraine University, Paris Descartes University, EA 4360 Apemac, 54505 Vandœuvre-lès-Nancy cedex, France
| | - Rémy Sebbah
- Regional Unions of Healthcare Professionals (Southeastern Region) - Self-employed Physicians (URPS-ML PACA), 13006 Marseille, France
| | - Patrick Peretti-Watel
- INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 13006 Marseille, France; Aix-Marseille University, IRD, UMR-S912, 13006 Marseille, France
| | - Pierre Verger
- INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 13006 Marseille, France; Aix-Marseille University, IRD, UMR-S912, 13006 Marseille, France; INSERM, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), GH Cochin Broca Hôtel Dieu, 75014 Paris, France.
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