Preventive service delivery: a new insight into French general practice

The importance of prevention is increasingly recognised in most developed countries. General practitioners (GPs) have got a key role to play in this domain in primary care. But, the research evidence still concludes that GPs' preventive activities remain most of the time insufficient. The aim of our study was to contribute to this debate in adopting a more broad view of prevention-related activities to better understand the GPs practice in this matter. Our study was undertaken to measure the part of prevention-related activity hidden in each of the morbid conditions (MC) seen by the doctors daily.

We carried out a cross-sectional study in a sample of 75 French GPs in the south suburb of Paris. We dropped the usual pre-established and limited list of specific preventive care activities to replace it with a list of 100 most common morbid conditions seen by the GPs in daily practice. The GPs were asked for each selected MC to rate on a five-item Likert scale the amount of primary and secondary prevention they generally offer during a patient visit.

All MC confounded, secondary prevention reached an average score of 3.2 (inter-quartile interval 2.82-3.58). The intensity of primary prevention was somewhat lower, but far from being negligible. Its average score was 2.3 (inter-quartile interval of 1.86-2.73). If more than 50% of the GPs declare a low intensity of primary prevention activity or even no primary prevention activity at all in nearly 3/4 of the MC encountered in their daily practice, they also declare that they carry out a considerable amount of primary prevention or in some cases spend the entire patient visit to primary prevention for MC covering more than 25% of their daily activity. Also, even if a majority of GPs did not give clear-cut scores for secondary prevention for 2/3 of the MC, they declare a considerable amount of it for the remaining 1/3 which covers more than 25% of their activity.

Our study was useful to offer a more realistic view of the real place of the prevention-related activities in the GPs daily primary care practice even if we assess neither the appropriateness nor the quality of these activities.