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Introduction : L’infection uro-génitale basse à Chlamydia trachomatis (Ct) est l’infection bactérienne sexuellement transmissible la plus fréquente en Europe, surtout chez les jeunes multipartenaires. Souvent asymptomatique, sa gravité résulte de son diagnostic tardif, justifiant un dépistage précoce. Objectif : Mettre en œuvre et évaluer une intervention complexe auprès des médecins généralistes (MG) des Alpes-Maritimes (06) visant à promouvoir le dépistage de l’infection à Ct chez leurs jeunes patients asymptomatiques Méthode : 105 MG randomisés ont reçu en visite confraternelle une information sur Ct, des outils et des kits d’auto-prélèvements permettant 10 inclusions durant 6 mois, action suivie d’une évaluation quantitative (nombre de dépistages prescrits/remboursés pour les MG visités et pour l’ensemble des MG du 06, comparés à la même période en 2013) et qualitative (entretiens post-interventionnels avec MG et visiteurs). Résultats : Une augmentation globale du nombre de dépistages entre les deux saisons 2013-2014 (15 %) a été observée, significativement majorée par l’intervention (73 %), p = 0,02. Parmi les 73 (48 %) patients ayant accepté d’effectuer un test de dépistage, 12 étaient infectés (réaction en chaîne par polymérase [PCR] positive). Les entretiens post-interventionnels auprès des MG et des médecins visiteurs ont mis en évidence des facteurs facilitants et des barrières au dépistage. Conclusion : Notre intervention, favorablement accueillie par les MG, a démontré sa faisabilité et son impact potentiel dans les conditions réelles du soin primaire. Les MG participants ont pu surmonter les nombreux freins identifiés à ce dépistage. Pour pérenniser cette intervention, les outils évalués pourront être mis à la disposition des MG en ligne et lors de formations sur la santé sexuelle.

Background General practitioners (GPs) play a central role in vaccinating the population in France. In a context of mistrust regarding vaccination, and because patients increasingly question their GP about vaccines, we designed the continuing medical education (CME) module in order to 1) reinforce GPs knowledge about vaccination 2) help GPs answer questions most frequently asked by their patients and 3) evaluate the impact of this module on their vaccine prescriptions. Methods The CME module lasted 3 hours and focused on MMR, meningitis C and seasonal influenza vaccines; GPs were given confidential feedback information on percentages of their patients vaccinated. We included GPs practicing in Southeastern France and with less than 60% of their child patients (aged between 10 and 34 months) with 2 reimbursements of MMR vaccines (data obtained from the Health Insurance Fund). Eligible GPs were then randomly assigned to three groups: those offered either a face-to-face or e-learning CME module and a control group without CME. We used vaccine reimbursement rates for MMR 2-doses, Meningitis C, seasonal influenza as proxies for vaccine prescription rates, and a difference in differences approach to compare reimbursement rates in the year before the CME session and in the 24 months post-intervention. Results Compared to the control group, vaccine reimbursement rates for 2-dose MMR and meningitis C increased by 6% and 4% respectively (p < 0.05) among patients of GPs who participated in the face-to-face CME session (52 GPs, with 1 842 children). For seasonal influenza vaccine, we found a 12% increase in the face-to-face group (p < 0.01). We found no statistically significant increase in the e-learning group (19 GPs, with 674 children) whatever the vaccine. Conclusions We found a modest impact of face-to-face CME session with feedback on GPs practices for childhood vaccines and a stronger one for seasonal influenza. Key messages The very positive feedback from face-to-face training highlights the fact that this type of training, which bring knowledge on vaccination in general and specific vaccines to GPs, is necessary. We found weak evidence for efficiency of CME sessions associated with audit/feedback to modify GPs practices regarding MMR and meningitis C vaccines.

Issue/problem Potentially inappropriate prescriptions (PIP) for the elderly constitute a major issue in the quality of ambulatory care. In France, people aged 80 years or older use on average five drugs per day. This polypharmacy is justified in most cases by multimorbidity but it increases the risk of adverse events. Description of the problem In order to optimize general practitioners’ (GPs) prescribing practices for the elderly, a project involving the Southeastern Health Regional Observatory (ORS Paca), the Regional Medical Department of Health Insurance Fund (DRSM Paca-Corse) and the Regional Union of Private Practitioners (URPS-ML Paca) was conducted in 2014-2016. Its main objective was to set up a regional mapping tool giving GPs access to drug prescriptions indicators for the elderly in their practice area. Results Based on national guidelines and advice of experts in the field, we calculated 7 different indicators of potentially inappropriate prescriptions (PIPs) for people aged 65 years or older, using drug reimbursement data from the Health Insurance Fund. Those indicators were calculated among patient lists of GPs and covered prescriptions of benzodiazepines, non-steroidal anti-inflammatory (NSAI) drugs, new oral anticoagulants, proton pump inhibitors, antiplatelet therapy... PIPs’ prevalence were calculated among GPs’ lists of patients. PIPs prevalence differed between drugs type, GPs and territories: for example, the age standardized prevalence of long-term treatment with NSAI drugs varied in 2014 from 2 to 15% between municipalities and from 0 to 14% in 2017. Lessons These results allowed to identify priority areas for intervention, in which continuous medical education sessions with an individual feedback to GPs on their own indicators were implemented, to improve prescribing practices. Key messages A substantial proportion of elderly people receive PIPs. Medico-administrative databases can be used to produce indicators of prescription practices to be used to guide public health interventions.