Background Multiprofessional practice is a key component in primary care. Examining general practitioner (GP) referral frequency to non-physician health professionals (NPHP) can provide information about how primary care is organised and works which is useful for policymakers. Our study aimed to describe French GP referral frequency to various NPHPs in France and identify associated factors. Methods This is an ancillary study to the observational, cross-sectional (ECOGEN) study conducted in 2011/2012 in France among 128 GPs. Data about consultations using the standardised International Classification of Primary Care (ICPC-2), and patient and GP characteristics were collected from 20,613 GP consultations. Referrals were identified through inductive and deductive approaches using ICPC-2 codes, keywords, and deep, open manual searches. Referral frequency was described overall and per NPHP. Patient, GP, and consultation-related factors associated with referral rates were described for the three most frequently identified NPHPs. To minimise potential sources of bias, this observational study followed the STROBE guidelines. Results French GPs referred 6.8% of patients to NPHPs, with physiotherapists, podiatrists, and nurses accounting for 85.2% of referrals. Older patients, retired patients, multiple health problems managed, and longer consultation durations were found to be associated with higher referral rates (p < 0.001). Specific trends were observed for nurse, physiotherapist, and podiatrist referrals. Women (p < 0.001) and regular patients (p = 0.002) were more likely to receive physiotherapy referrals while people with no professional activity were less likely (p < 0.001). Female GPs and those working in urban practices were more likely to issue a physiotherapy referral (p < 0.001), while GPs working in rural practices (p < 0.001) and those with higher annual consultation numbers (p = 0.002) were more likely to refer to a nurse. Working in multiprofessional centres appeared to have little impact on referral rates, being only slightly associated with podiatrist referrals (p = 0.003). Conclusions Referral frequency is more associated with patient characteristics and clinical situations than GP-related factors suggesting patients needing referral most are most often referred. Furthermore, the three NPHPs that GPs refer to the most are those for which a referral is required for reimbursement in France, suggesting that health system legislation and NPHP reimbursement are strong determinants for referrals.
Contexte : Apprendre à communiquer avec les patients pour favoriser la relation est un objectif de formation du deuxième cycle des études médicales en France. Des séances inspirées du théâtre-forum d’Augusto Boal pourraient permettre le développement contextualisé de cette compétence professionnelle. But : Évaluer l’intérêt du théâtre-forum pour la formation des étudiants en médecine à la communication et la relation médecin-patient. Méthodes : Depuis 2014, les étudiants en quatrième année de médecine ont participé à des séances d’enseignement inspirées du théâtre-forum. Des situations potentiellement difficiles entre médecin et patient ont été jouées par des comédiens, puis les étudiants ont été invités à intervenir successivement pour proposer des alternatives possibles. Des questionnaires ont été distribués aux étudiants afin d’évaluer ce dispositif. Le critère de jugement principal quantitatif était la note attribuée à l’enseignement. Les critères qualitatifs exploraient les réactions et ressentis des étudiants. Résultats : Sur 776 questionnaires distribués, 688 ont été analysés. Les étudiants ont attribué une note moyenne de 7,79/10 à cet enseignement. Plus de 80 % d’entre eux ont estimé avoir été sensibilisés aux objectifs pédagogiques d’annonce de maladie grave et de relation-communication avec les patients. Le caractère pratique et le réalisme de l’enseignement ont été les principaux avantages cités par les étudiants. Ils ont également apprécié son caractère réflexif. Cependant, la présence d’un public a représenté une difficulté pour certains. Conclusion : Le théâtre-forum semble un dispositif pédagogique innovant apprécié des étudiants et utile pour les sensibiliser à la communication dans la relation médecin-patient.
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