Preventive practice in general medicine in the Rhone-Alps region

The Fifth Health Conference in the Rhone-Alps which took place in early 2001 provided the ideal opportunity and forum for holding a debate about prevention in ambulatory care. In order to provide arguments supporting a wider basis for reflection, the Regional Department of Social and Health Affairs in the Rhone-Alps initiated a study focusing on preventive practices of general practitioners in various areas such as vaccination follow-up procedures; care provided to the elderly; gynaecology, life styles and additions (alcohol, tobacco, and drugs). Utilising the network of the Association for the Development of Medical Information (A.D.I.M.), a representative sample of 80 general practitioners working in the Rhone-Alps region was constituted, which allowed for the inclusion of 3,658 patients from July to December 2000. Results show a distortion between objective preventive practices measured with different physicians' activity scores in the aforementioned areas and the estimated level of effectiveness determined from individual physician's statements. The subsequent calculation of these scores, based on a large sample of patients with similar characteristics to the general population, provide an objective reality from the care consumer's perspective: there is an overall lack of prevention on the part of physicians. The physicians themselves cite the lack of time; an inadequate system of payment and insufficient training as causes for this situation. The implementation of an economic incentive system could facilitate the development preventive practice in general medicine and ambulatory care.