Objectives To analyse the views of general practitioners (GPs) about how they can provide care to homeless people (HP) and to explore which measures could influence their views. Design Mixed-methods design (qualitative –> quantitative (cross-sectional observational) → qualitative). Qualitative data were collected through semistructured interviews and through questionnaires with closed questions. Quantitative data were analysed with descriptive statistical analyses on SPPS; a content analysis was applied on qualitative data. Setting Primary care; views of urban GPs working in a deprived area in Marseille were explored by questionnaires and/or semistructured interview. Participants 19 GPs involved in HP's healthcare were recruited for phase 1 (qualitative); for phase 2 (quantitative), 150 GPs who provide routine healthcare (‘standard’ GPs) were randomised, 144 met the inclusion criteria and 105 responded to the questionnaire; for phase 3 (qualitative), data were explored on 14 ‘standard’ GPs. Results In the quantitative phase, 79% of the 105 GPs already treated HP. Most of the difficulties they encountered while treating HP concerned social matters (mean level of perceived difficulties=3.95/5, IC 95 (3.74 to 4.17)), lack of medical information (mn=3.78/5, IC 95 (3.55 to 4.01)) patient's compliance (mn=3.67/5, IC 95 (3.45 to 3.89)), loneliness in practice (mn=3.45/5, IC 95 (3.18 to 3.72)) and time required for the doctor (mn=3.25, IC 95 (3 to 3.5)). From qualitative analysis we understood that maintaining a stable follow-up was a major condition for GPs to contribute effectively to the care of HP. Acting on health system organisation, developing a medical and psychosocial approach with closer relation with social workers and enhancing the collaboration between tailored and non-tailored programmes were also other key answers. Conclusions If we adapt the conditions of GPs practice, they could contribute to the improvement of HP's health. These results will enable the construction of a new model of primary care organisation aiming to improve access to healthcare for HP.
Contexte. La pratique de l’échographie est de plus en plus répandue chez les médecins généralistes (MG). L’échographie clinique ciblée (ECC) prolonge l’examen clinique et permet de mieux gérer l’incertitude diagnostique. Son utilisation reste mal connue et peu réglementée. Objectifs. L’objectif principal était d’identifier les indications pour lesquelles l’utilisation de l’ECC était jugée pertinente comme aide diagnostique. Les objectifs secondaires étaient de quantifier, pour chacune des indications, le taux de pratique parmi les MG et la part de MG réalisant majoritairement une ECC, et de rechercher les facteurs influençant le choix entre ECC et échographie standard (ES). Méthode. Une étude descriptive transversale multicentrique a été menée par questionnaire auprès de MG libéraux français, avec une pratique régulière mais non exclusive de l’échographie. Ils étaient interrogés sur 30 indications. L’indication était retenue si plus de 70 % des MG la jugeaient pertinente. Résultats. Les 93 MG inclus étaient issus de formations diverses. Pour 23 indications, l’utilisation de l’ECC a été jugée pertinente. Plus de 60 % des MG pratiquaient 26 des 30 indications. L’ECC était plus fréquemment choisie que l’ES pour 19 indications, notamment parce qu’elle était suffisante pour les MG et plus rapide à réaliser. Être formé depuis plus longtemps et pratiquer sans créneau dédié avaient un impact significatif sur le nombre d’ECC par semaine. Conclusion. Cette étude a retenu 23 indications d’ECC réalisables en cabinet de MG, dont 16 pour lesquelles l’ECC était plus fréquemment pratiquée que l’ES. L’ECC a toute sa place en médecine générale, et pourrait permettre de réduire le coût global des soins. Mieux définir son cadre, sa rémunération et sa formation pourrait en favoriser le développement.
Patients suffering from mental health disorders have complex care needs, associating poorer physical health status and depreved social condition. Given their central role in primary health care, GPs should be highly involved in providing global and cooperative care to these patients in partnership with mental health specialists.To understand the GP's views, attitudes and needs in the care of patients with mental disorders.We led a qualitative study from June to July 2017, with semi-structured interviews led on GPs' activity in Marseille (France). We performed an inductive thematic content analysis, using Excel software.We interviewed 22 GPs. The GPs felt comfortable providing total care for their patients with anxiety and depression (most of the time perceived as 'minor cases'), whereas they felt uncomfortable and poorly integrated in the care of patients with psychotic symptoms (often perceived as 'severe'). They wanted to improve communication with psychiatrists.The GPs seemed to assess the complexity of the cases and therefore their ability to deal with them, based on the type of their patients' psychiatric symptoms. For the 'severe patients', they felt they didn't have a significant role to play as a family doctor, while it has been shown that these patients have poorer physical health and need more coordinated care than other patient groups. An improved communication between GPs and mental health providers could reduce the difficulties for GPs in the care of people with mental health disorders and make possible a whole patient-centred approach.
Vulnerable people have complex health needs but face multiple barriers to accessing healthcare. In 2018, Médecins du Monde (MDM), a French non-governmental association which care for underserved people, initiated an ambulatory primary care network in Marseille, France: the "PASS De Ville" (PDV). It supports vulnerable populations in obtaining immediate access to common primary care in the city before their health insurance rights are established. We aimed to assess the experience and care expectations of the patients who used the PDV. We conducted a qualitative study based on a grounded theory approach. Patients who met at least one of the general practitioners involved in the PDV were included. We conducted semi-structured interviews amongst 16 service users, between February and May 2021. Two researchers performed an inductive analysis using NVivo. The patients had both medical and non-medical needs. Alongside health, access to health insurance was a subject often considered a key priority. Although patients seemed to have little understanding of how the PDV works, they nevertheless managed to benefit from it and access medical care more easily. PDV users reported feeling more socially integrated through consideration by healthcare givers. Most of them still identified the general practitioner encountered during the PDV as their referent doctor once their health insurance rights were established. The PDV seems to support better integration into the French primary care system for patients who encounter barriers seeking medical care. Other studies are needed to identify PDV's efficiency on care pathways and patients' overall health.
Screening and care for victims of sexual violence (SV) among asylum seekers and refugees (ASRs) living in High-income host countries were prioritized by the WHO in 2020. The lack of stabilized prevalence findings on lifetime SV among ASRs in High-income countries hinders the development of adequate health management. The objective of this study was to determine the lifetime prevalence of SV experienced by ASRs living in High-income countries. We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included in the meta-analysis if the sample consisted exclusively of asylum seekers or refugees over the age of 16 living in High-income countries and if they reported a lifetime prevalence of experienced SV. The results of the meta-analysis were expressed with 95 % confidence intervals (CIs) as estimates of lifetime SV prevalence using a random-effects model. The estimated lifetime prevalence of SV among women ASRs was 44 % (95 % CI, 0.24-0.67) and 27 % (95 % CI, 0.18-0.38) for both sexes. This meta-analysis revealed a high prevalence of SV among ASRs hosted in High-income countries and suggest the importance of developing specific screening and care programs in these host countries.
Abstract Chronic cannabis use can be associated with uncontrollable vomiting and abdominal pain. Diagnostic criteria for cannabinoid hyperemesis syndrome (CHS) were defined in 2012 by Simonetto et al. The objectives of this study were to describe the prevalence of CHS, the patients' epidemiological characteristics, and to show the difficulties encountered in caring for these patients in emergency departments, the extent of health care and an unsuitable follow‐up in general practices. A prospective cohort of patients with CHS was recruited among a target population of patients leaving the adult emergency services of the Marseille hospitals Nord and La Timone between October 2017 and July 2018, with abdominal pain syndrome of unidentified etiology. Inclusion criteria for the CHS cohort were chronic cannabis use associated with nausea and vomiting. There were 48 patients included in the CHS cohort who took cannabis daily, in a target population of 2 848 patients (i.e. 1.6%). A hot shower was the most effective symptomatic treatment in 54.2% of cases. Patients suffering from CHS spent significantly more hours in emergency departments (11 vs. 6.5), and, on average, visits were more frequent (4.9 vs. 3). 20.3% of them were hospitalized to continue pain medication. Once out of hospital, follow‐up was limited, and weaning off cannabis, the only etiological treatment, was difficult to set up. Informing patients about CHS is essential, and a hot shower could be systematically proposed, thus limiting an unnecessary extent of health care. CHS is genuine, medical staff should be made aware of it in occupational training, and it should be seriously considered in health policies.
