Étude des problèmes rencontrés par les médecins généralistes dans la prise en charge de leurs patients opérés en ambulatoire à la polyclinique de Navarre de Pau durant l’année 2017

Abstract : The Ministry of Social Affairs and Health fixed as development objective "a global outpatient surgery rate of 66.2% by 2020". General practitioners are not enough integrated into their patient care path and not enough trained in the ambulatory care mode follow-up. This study has been conducted in order to identify the frequency and nature of encountered problems by general practitioners in the management of postoperative outpatient surgery patients at the polyclinic of Navarre in Pau in 2017. Methos: we conducted a retrospective descriptive cross-sectional and quantitative study by questionnaire which was intended to general practitioners and sent by post. 134 physicians were contacted in March 2018 regarding the 220 randomly selected patients with outpatient surgery at the Navarre clinic in 2017. We used the returned questionnaires until May 1st, 2018. The questionnaires responses were reported in a spreadsheet as an Excel® table and were processed anonymously. The project has been approved by the CNIL (Commission Nationale Informatique et Liberté). Results: between March and May 2018, 60 general practitioners returned 94 questionnaires. The general practitioners study participation rate was 46.8% providing desired information for 44.3% of patients randomly selected. 72% of general practitioners surveyed said they did not feel sufficiently informed about the expected outcomes and only 10% received training on outpatient surgery. 9% of patients consulted their general practitioner for a complication within 72 hours postoperative outpatient surgery. Reasons for consultation were pain (88%) and suspicion of infection (63%). Other reasons that led to consultation were comorbidity decompensation, digestive disorders, or local wound care. The pain was dealed with mild or moderate difficulty for two practitioners working with two different patients, infection was a mild source of difficulty for one practitioner, and each case of co-morbid decompensation, wound care or digestive disorders was source of mild difficulty. General practitioners considered that complementary document would have been useful for 51% of patients management case, including "postoperative instructions and medical supervision ", with "expected follow-up details” or "hospitalization report". 97% of general practitioners declared they could benefit from a help tool to guide them in the postoperative management of their patients operated on an outpatient surgery. 55% of general practitioners wanted to join an outpatient referring doctor available 24 hours a day at the polyclinic of Navarre. Then, 45% of general practitioners have chosen an advice booklet given to the patient, 43% have chosen cards containing protocols foreseeable complications and 38%have chosen a website that would gather the advice of surgeons. In open-ended comments, 12% of general practitioners reported discontent with postoperative follow-up and medical supervision of outpatient surgery patients. Conclusion: until now, general practitioner is rarely called upon to intervene in the patient's postoperative management, but in the case that practitioner has to intervene he feels not enough trained and not enough associated with his patient outpatient care. The recourse frequency to general practitioners will probably evolve with the gradual inclusion in ambulatory patients with chronic diseases, and for heavier surgical procedures. Collecting their difficulties and needs and then proposing a tool to help with the management of postoperative complications of outpatient surgery shows the desire for better communication between the team of the outpatient surgery unit of Navarre polyclinic and general practitioners.
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Master Thesis
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Lauren Nielsen. Étude des problèmes rencontrés par les médecins généralistes dans la prise en charge de leurs patients opérés en ambulatoire à la polyclinique de Navarre de Pau durant l’année 2017. Sciences du Vivant [q-bio]. 2018. ⟨dumas-01969215⟩



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