1. 15e WONCA EUROPE Conference 16-19 September 2009 Basel Switzerland
What kind of devices are available in French GPs’ offices to promote health education in general practice?
Jean Luc GALLAIS* MD, François DUMONT** MD ,
Patricia MERCIER* ** MD, Gilles MOREL* **MD
*ADESA 13 rue F. Léger. Paris (France) ** Département de Médecine Générale, 7 bd Jeanne d’Arc, Dijon (France)
Context
About 15 millions people (one quarter of the french population) suffer from chronic diseases.
Health education and chronic disease management in primary care require specific devices and methods to help health providers to promote patients’ autonomy, competences and skills.
Objective
To describe GPs’ office equipment (and cost).
To know what kind of devices or tools are available in French GPs’ offices to promote health education,
To describe GPS’ opinions and feelings about patient health education.
Methods
Self-assessment forms – electronic format – related to office equipments and opinions in a national sample of 400 French general practitioners.
We studied 4 items among 60 office tools or devices : leaflets to take away in waiting rooms, health websites lists for patients, list of auto support groups addresses, and specific health files available for reading in waiting rooms.
We also considered population data corresponding to the office location, provided by national census, and the rural -urban location of the GP’s practice.
Uni and multivariate analyses were performed.
Results
The physicians who filled up the questionnaires had features similar to those reported in the national databases for gender, mean age and activity level.
The rural-urban distribution was the same as in the whole french territory.
Main findings: The proportions of GPs owning health education devices were the followings :
22.8% [CI ] specific health files in waiting rooms,
53.8% [CI 48.7 – 57.7] addresses of auto-support groups,
22.6% [CI ] lists of health web-sites for patients,
56.3% [CI 54.7 – 64.3] health leaflets to take away.
Those rates were linked to the GPs’ gender, offices’ location and to the ownership of other health education equipment.
The study underlined significant associations :
For instance : other items linked to the presence of health files available for reading in waiting rooms:
1) Univariate analysis:
Female gender (Chi-Square )
Phones of auto-support associations (Chi-Square < 0.001)
List of websites for patients’ information (Chi-Square 0.003)
Leaflets to take away (Chi-Square <0.001)
Cost of total equipment in office (Chi-Square )
2) In multivariate analysis, the relevant items were the same but the cost of offices’ equipment and the gender of GP were not statistically significant.
GPs’ opinion and feelings
GPs’ opinions in health education : 96.4% stated to be motivated by their job.
But only 8 out of 10 GPs felt comfortable in their practice, and 7 of them thought they were efficient. Half of the GPs planed changes in practice, even if 80% said they needed specific continuous medical education concerning health education.
Nearly half of the physicians did not wish to recommend web sites.
Analyse & Discussion
The ownership of those devices constitutes an indicator of the GPs’ interest in health education. Since we had no data on their daily use, these findings need additional researches on their levels of use.
It is needed to underline that each type of device recquires specific training and skills, abilities to communicate and therefore time. A new law was published in France in 2009, to aim at organising health education at national and regional level in public and liberal practices, for out and inpatients.
There are still debates about defining the responsibilities of each health provider, organizing shared care, deciding financial incentives and promoting adequate tools and methods.
Conclusion
Offices’ equipments in health education for outpatients in general practice need to be improved with a higher commitment of physicians.
This study highlights debates on health education in primary care and general practice: What kind of devices and means are needed for which aims and for which health providers? These questions are arising in national health insurance, health agencies and general practitioners organisations.
ADESA thanks all French GPs and the team involved in this research in general practice.
ADESA Association de Développement des Soins Ambulatoires (Loi 1901, no profit organisation)
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