Philippe Vorilhon

Health Care Support Issues for Internationally Adopted Children: A Qualitative Approach to the Needs and Expectations of Families

Background Families of internationally adopted children may face specific problems with which general practitioners (GPs) may not be familiar. The aim of the study was to explore problems faced by families before, during and after the arrival of their internationally adopted child and to assess the usefulness of a specific medical structure for internationally adopted children, which could be a resource for the GP. Methodology/Principal Findings We conducted a qualitative study using individual semistructured guided conversations and interviewed 21 families that had adopted a total of 26 children internationally in the Puy de Dome department, France, in 2003. Quantitative data were used to describe the pathologies diagnosed and the investigations performed.Our study showed that the history of these families, from the start of the adoption project to its achievement, is complex and warrants careful analysis. Health-care providers should not only consider the medical aspects of adoption, but should also be interested in the histories of these families, which may play a role in the forming of attachments between the adoptee and their adoptive parents and prevent further trouble during the development of the child. We also showed that adoptive parents have similar fears or transient difficulties that may be resolved quickly by listening and reassurance. Most such families would support the existence of a specific medical structure for internationally adopted children, which could be a resource for the general practitioner. However, the health-care providers interviewed were divided on the subject and expressed their fear that a special consultation could be stigmatizing to children and families. Conclusions/Significance A specific consultation with well-trained and experienced practitioners acting in close collaboration with GPs and paediatricians may be of help in better understanding and supporting adopted children and their families.

Cannabis and Young Users—A Brief Intervention to Reduce Their Consumption (CANABIC): A Cluster Randomized Controlled Trial in Primary Care

PURPOSE Brief intervention to reduce cannabis is a promising technique that could be adapted for use in primary care, but it has not been well studied in this setting. We tested the efficacy of a brief intervention conducted by general practitioners among cannabis users aged 15 to 25 years. METHODS We performed a cluster randomized controlled trial with 77 general practitioners in France. The intervention consisted of an interview designed according to the FRAMES (feedback, responsibility, advice, menu, empathy, self-efficacy) model, while the control condition consisted of routine care. RESULTS The general practitioners screened and followed up 261 young cannabis users. After 1 year, there was no significant difference between the intervention and control groups in the median number of joints smoked per month among all users (17.5 vs 17.5; P = .13), but there was a difference in favor of the intervention among nondaily users (3 vs 10; P = .01). After 6 months, the intervention was associated with a more favorable change from baseline in the number of joints smoked (−33.3% vs 0%, P = .01) and, among users younger than age of 18, smoking of fewer joints per month (12.5 vs 20, P = .04). CONCLUSIONS Our findings suggest that a brief intervention conducted by general practitioners with French young cannabis users does not affect use overall. They do, however, strongly support use of brief intervention for younger users and for moderate users.

French women's representations and experiences of the post‐treatment management of breast cancer and their perception of the general practitioner's role in follow‐up care: A qualitative study

In France, the Cancer Plan II 2009‐2013 was launched to improve post‐cancer management and promote greater involvement of general practitioners (GPs) in follow‐up care.

AB1072 General Practitioner Perceptions of Methotrexate and anti-TNF Treatments: A Qualitative Study

Background The objective of rheumatic disease management is to achieve remission. Methotrexate (MTX) is the first-line treatment choice and tumor necrosis factor alpha antagonists (anti-TNFs) are used in case of MTX failure or intolerance. While these treatments are initially prescribed then renewed by rheumatologists, general practitioners (GPs) are often confronted with them during routine patient follow-up. Objectives We sought to study the perceptions of GPs from Auvergne (a region of France) regarding MTX and anti-TNFs treatments in common daily practice. Methods A qualitative study was carried out among 14 GPs following up patients receiving methotrexate and anti-TNFs. The semi-structured interviews were conducted between May and October, 2014. Thematic transversal analyses of the data were conducted by both the interviewer and an independent researcher. Each difference detected between them was discussed, then resolved by consensus. Results Of the 285 physicians who completed a preliminary questionnaire, 31 consented to participate in the qualitative. A total of 14 interviews, sufficient to obtain data saturation, i.e., until no new data emerged, were conducted, lasting between 8 minutes and 1 hour, with a mean duration of 23 minutes 30 seconds. In total, 57% of the physicians interviewed were female and 42% of all practiced within 15km of a rheumatologist. The participating physicians were either young doctors (14%) or had over 20 years of experience (78%). Four principal themes were recognized in the analysis: the GPs role with regard to the patients, their experience and difficulties concerning these treatments, their opinions of therapeutic education programs, as well as the need for improvements in clinical practices. The physicians role consisted in renewing methotrexate prescription (10/14) and managing comorbidities via vaccination, for example (7/14). The GPs reported good tolerance (10/14) and efficacy (8/14) with the treatments. However, there was still concern over the immunosuppression and increased infection risk associated with these treatments, causing them to hesitate in using them. The difficulties especially concerned drug interactions and managing anti-TNF discontinuation in the event of infection (5/14), especially for rural-based practices with less easy access to specialists. All the physicians expressed a desire for a practical tool to be implemented aiding them to manage these treatments (10/14). Conclusions All the physicians reported difficulties in their daily management of these treatments. Close collaboration between GPs and specialists thus appears essential for this management. GP training is also to be encouraged. Disclosure of Interest None declared

AB0829 2012 American Guidelines for The Management of Gout as Seen by Family Doctors in France

Background Gout is a common and potentially serious rheumatological disease. Its management in France remains inadequate, with target serum uric acid (SUA) levels being reached in 20% of cases. American guidelines for the management of gout were released in 2012. Objectives Our aim was to assess whether family doctors in Auvergne, France, agreed with the 14 recommendations for managing gout by mailing them a questionnaire. Methods An anonymous questionnaire was mailed to all the family doctors in our region in November 2014. Results The response rate was 40% (n=505/1263). Of the 505 family doctor respondents (FDRs), 60% had been in practice for more than 20 years. Some 56.2% were in practice in rural areas, and 53.6% followed on average 5 to 20 gout patients. Management of acute gout: 90.7% of FDRs agreed with pharmacological management within 24 hours of the attack; 95% of FDRs agreed with using colchicine, 72% short-course nonsteroidal anti-inflammatory drugs, and 16.6% corticosteroids; 81% approved of continuing hypouricemic therapy during the attack. Management of chronic gout: 61.6% agreed with not treating asymptomatic hyperuricemia. Allopurinol or febuxostat are used as the first-line therapies according to 88.7%. Half of respondents lowered target SUA when gout was tophaceous. Conclusions The guidelines generally met with the approval of family doctors in Auvergne (72% agreement). They were also confirmed on a European level in 2014. Their use should be disseminated with, however, some additional clarifications, particularly for the management of chronic gout. Disclosure of Interest None declared