Raphaëlle Delpech: Department of General Practice, University of Paris-Saclay, Paris, France.
Lorraine Poncet: CESP (Centre for Research in Epidemiology and Population Health), Inserm U1018, University of Paris-Saclay, UVSQ, Gender, Sexual and Reproductive Health Team, Paris, France.
Arnaud Gautier: Santé Publique France, Saint-Maurice, France.
Henri Panjo: CESP (Centre for Research in Epidemiology and Population Health), Inserm U1018, University of Paris-Saclay, UVSQ, Gender, Sexual and Reproductive Health Team, Paris, France.
Rissane Ourabah: Department of General Practice, University of Paris-Saclay, Paris, France.
Pascaline Mourey: Department of General Practice, University of Paris-Saclay, Paris, France.
Mathilde Baumhauer: Department of General Practice, University of Paris-Saclay, Paris, France.
Isabelle Pendola-Luchel: Department of General Practice, University of Paris-Saclay, Paris, France.
Virginie Ringa: CESP (Centre for Research in Epidemiology and Population Health), Inserm U1018, University of Paris-Saclay, UVSQ, Gender, Sexual and Reproductive Health Team, Paris, France.
Laurent Rigal: Department of General Practice, University of Paris-Saclay, Paris, France.
BACKGROUND: General practitioners (GPs) do not systematically include preventive recommendations in their practice, and some characteristics of health care organization are associated with more systematic prevention. But the characteristics of health care organization may act in a nonuniform manner depending on the type of preventive care. Thus, one characteristic can be positively associated with one type of preventive care and negatively associated with another. Our aim was to investigate the association between health care organization in general practice and different areas of preventive care (immunization and addiction prevention), in search of nonuniform associations. METHODS: We used a representative survey of 1,813 French GPs conducted in 2009. Four preventive care practices were studied: immunization through flu and HPV vaccination, and prevention of addictive behaviors concerning tobacco and alcohol use.Characteristics of GPs' health care organization and the social context of their practice were collected (spatial accessibility to GPs and socioeconomic level of the area of practice). We constructed mixed models to study associations and interactions between the organization variables and preventive care. RESULTS: Four out of five characteristics of GPs' organization have uneven impacts on different types of preventive care (p-interaction < 10-4). For example, number of daily consultations is associated with better immunization prevention but with poorer prevention counseling in addictive behaviors. In contrast, working with digital medical files is uniformly associated with both types of preventive care (OR = 1.29 [1.15-1.45]; P < 10-4). CONCLUSION: An approach centered on specific types of preventive care should help deepen our understanding of prevention and possibly help to identify a new typology for preventive care.
References
Health Promot Pract. 2015 Sep;16(5):745-55
[PMID: 25445979]
Br J Gen Pract. 1999 Mar;49(440):187-90
[PMID: 10343420]
EBioMedicine. 2015 Jun 23;2(8):891-7
[PMID: 26425696]
BMC Fam Pract. 2019 Aug 15;20(1):114
[PMID: 31416425]
Scand J Public Health. 2002;30(2):141-7
[PMID: 12028863]
