Benoit Tudrej

Improving public health information for patients: shared decision making and influenza vaccination

Shared decision making (SDM) is a process that every health professional should apply when there is scientific uncertainty between several care strategies. Papers have established quality criteria and tools to help in SDM.1 In 2012, the International Patient Decision Aids Standards (IPDAS) updated its quality criteria at an international expert consensus conference. The changes were published in a supplement in BMC Medical Informatics and Decision Making .2 In this field, patients and doctors expect SDM to be done from the best available research evidence.3 IPDAS recommends that shared decision tools are comprehensive and up-to-date summaries of scientific data, and that the evidence itself should be subject to critical appraisal.3 In this context, we analysed annual influenza vaccination in the over-65s. This is a typical example of where shared medical decision making is of major importance, because it deals with prevention in an asymptomatic population. The aim is to discuss the situation with the patient so that they can make their own decision, not only from objective information given by the doctor, but also from their own subjective viewpoint. With regards to influenza vaccination in the over-65s, scientific facts on the benefits are uncertain and communication of facts has caused controversy.4,5 Thus far, no randomised controlled trial (RCT) has rigorously analysed the clinical efficacy of the vaccine in the over-65s on clinically pertinent outcomes, such as mortality or hospitalisation. Our aim was to analyse the content of the documents made available on the web by French and British health authorities, on the Assurance Maladie6 and NHS Choices …

The patient revolution demands more accountability.

Nothing can stop the “patient revolution.”1 For some doctors this is the sign of deconsecration of medicine. For others, it is a new opportunity for patients’ autonomy. Patients will improve our approach to research as …

Even if they are not aware of it, general practitioners improve well-being in their adolescent patients

Abstract Background: Most adolescents consult their general practitioner (GP) for common reasons, somatic or administrative but many of them have hidden feelings of distress. Objectives: To assess the immediate impact of ‘ordinary’ consultations on feelings of distress among adolescents and to compare adolescents experiencing difficulties (D) to those with no difficulties (N). To analyse how accurately GPs assess the impact of their consultation on adolescents’ feelings. Methods: GPs were randomly selected from two non-contiguous French administrative areas between April and June 2006. Fifty-three GPs gave two questionnaires to the first 10 to 15 adolescents aged 12 to 20 seen in consultation. One questionnaire was issued before the consultation and the other one afterwards. Adolescents had to position themselves about different aspects of well-being and say where they would seek help if they had problems. A GP questionnaire assessed how well they estimated their impact on the adolescent’s feeling of well-being. Results: Six hundred and sixty-five adolescents were assessed. They reported feeling better about their health, being able to talk, having someone to talk to or to confide in and on feeling understood. The D group (n = 147) felt significantly better compared to the N group (n = 518). GPs tended to underestimate this improvement, especially regarding adolescents in the D group feeling better about their health. Conclusions: Consulting a GP generates increased well-being among adolescents, especially for those experiencing difficulties. GPs tend to underestimate the positive impact they may have. Further studies are needed to explore if this benefit is permanent over time.

Les médecins généralistes lisent-ils les sources primaires d’information ?

Il s’agit d’une enquete descriptive transversale par questionnaire via Internet realisee de juin a octobre 2015 pour evaluer les sources d’informations utilisees par les internes de medecine generale (IMG) et les maitres de stage universitaire en medecine generale (MSU) pour alimenter leurs connaissances sur l’efficacite de sept medicaments utilises couramment en soins premiers.La population etudiee etait les MSU et les IMG de 4 universites (Poitiers, Lyon, Nantes et Strasbourg). Les questions portaient entre autres sur les sources utilisees pour repondre a des questions sur l’efficacite des medicaments.Le taux de reponse a ete de 16 % et 476 questionnaires ont ete analyses (305 IMG et 171 MSU). Les recours aux sources d’informations primaires ont ete cites dans 6 % (essais cliniques randomises) a 8 % (meta-analyses d’ECR) des cas. Les 3 sources ou ressources principales citees etaient les recommandations HAS (41 %), les confreres specialistes ou l’experience personnelle (43 % et 39 % des cas respectivement). Il y avait peu de difference entre les internes et les maitres de stage.Ces resultats montrent qu’en majorite les IMG et les MSU ne lisent pas les sources d’information primaires pour alimenter leurs connaissances sur l’efficacite des medicaments. La mise en place de l’enseignement de la lecture critique d’articles dans la formation initiale ne semble pas avoir influence le recours a ces sources d’information par les internes. Il est donc necessaire que des sources d’informations secondaires de qualite soient accessibles pour que la pratique basee sur l’evidence based medicine (EBM) puisse etre une realite.

What do troubled adolescents expect from their GPs

Abstract Background: Adolescents often have emotional and behavioural problems that general practitioners are likely to miss. While nearly 80% of them consult their GP every year, it is usually for physical, not psychological reasons. Trust in their GPs in necessary for screening. Objectives: To identify the key quality desired by adolescents for them to feel free to confide in GPs. To determine whether this quality differed according to gender, level of at-risk behaviours or interlocutor: friend, parent or GP. Methods: A descriptive cross-sectional study was conducted in 182 French educational institutions chosen by lot. Fifteen-year-olds completed a self-administered questionnaire under examination conditions. While the questions on behaviour were drawn from the cross-national survey entitled ‘Health behaviour in school-aged children (HBSC),’ the questions on conditions conducive to trust were drawn from previous studies. Results: A total of 1817 (911 boys, 906 girls) questionnaires were analysed. Adolescents said they seldom confided. The main quality they expected from a GP to whom they could confide in was ‘honesty’, which meant ensuring secrecy, refraining from judgment, and putting forward the right questions. This priority was modified by neither gender nor experience with health-risk behaviour. The quality of ‘reliability’ was more closely associated with their parents or friends, while ‘emotionality’ was cited less often. Conclusion: To gain the trust of adolescents, GPs have to be sincere and non-manipulative and have the ability to ensure confidentiality and to put forward the right questions without passing judgment. Can this be verified during consultations? Prospective studies could shed light on this point.KEY MESSAGES Above all, troubled adolescents expect from their GP ‘honesty’, which meant secrecy, to refrain from judgment and to put forward the right questions. High-risk girls were the most inclined to talk to their GP about interpersonal problems but they were reluctant to talk about their bodies.