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Age (> 50 years) is a risk factor for pneumococcal disease, but is not an indication for vaccination in France, by contrast to influenza. In 2018, the pneumococcal vaccine coverage rate (VCR) was 4.5% in adults at-risk, in contrast to the influenza VCR, which was 43.6%. We aimed to assess pneumococcal and influenza VCR in 2020 in the entire French population and factors associated with a higher VCR (including the age of 65 years). We retrospectively included all adults covered by the National Health Service in 2020 and identified patients at-risk using validated algorithms. We assessed VCRs by analysing pneumococcal vaccines reimbursed between 2009 and 2020 (13-valent pneumococcal conjugate vaccine [PCV13] and 23-valent polysaccharide vaccine [PPSV23]), and influenza vaccines reimbursed between September 2020 and March 2021. In 2020, we identified 7,336,769 adults at risk (median age: 67.0 years): 84.2% had comorbidities and 24.5% were immunocompromised. The overall pneumococcal VCR (PCV13 + PPSV23) was 9.9% and the seasonal influenza VCR was 51.1%. The variable associated with the highest odds of VCR was an \"age ≥65 years\" for influenza (odds ratio [OR] 4.14), but not for pneumococcal vaccination (OR 1.02). In patients with comorbidities, pneumococcal VCR did not significantly increase between those aged 18-65 years and those aged > 65 years (7.2% to 9.4%), and even decreased from 20% to 17.9% in patients with immunodeficiencies. In contrast, influenza VCR increased significantly from 35.5% to 67.9% (OR 3.55) in patients with comorbidities, and from 27.3% to 71.2% (OR 5.57) in those with immunodeficiencies. In France, pneumococcal VCR did not increase above 65 years of age (OR 1.02), by contrast to influenza VCR (OR 4.14) that increased significantly, suggesting that an age-based recommendation for pneumococcal vaccination will probably benefit to VCR in at-risk, elderly population.

From one country to another, the pay-for-performance mechanisms differ on one significant point: the identification of target populations, that is, populations which serve as a basis for calculating the indicators. The aim of this study was to compare clinical versus medication-based identification of populations of patients with diabetes and hypertension over the age of 50 (for men) or 60 (for women), and any consequences this may have on the calculation of P4P indicators. A comparative, retrospective, observational study was carried out with clinical and prescription data from a panel of general practitioners (GPs), the Observatory of General Medicine (OMG) for the year 2007. Two indicators regarding the prescription for statins and aspirin in these populations were calculated. We analyzed data from 21.690 patients collected by 61 GPs via electronic medical files. Following the clinical-based approach, 2.278 patients were diabetic, 8,271 had hypertension and 1.539 had both against respectively 1.730, 8.511 and 1.304 following the medication-based approach (% agreement = 96%, kappa = 0.69). The main reasons for these differences were: forgetting to code the morbidities in the clinical approach, not taking into account the population of patients who were given life style and diet rules only or taking into account patients for whom morbidities other than hypertension could justify the use of antihypertensive drugs in the medication-based approach. The mean (confidence interval) per doctor was 33.7% (31.5-35.9) for statin indicator and 38.4% (35.4-41.4) for aspirin indicator when the target populations were identified on the basis of clinical criteria whereas they were 37.9% (36.3-39.4) and 43.8% (41.4-46.3) on the basis of treatment criteria. The two approaches yield very \"similar\" scores but these scores cover different realities and offer food for thought on the possible usage of these indicators in the framework of P4P programmes.

[Display omitted] •4.5% out of 4.0 million adults at risk were vaccinated against pneumococcus.•92% of adults at risk visited a GP and 36% visited an outpatient specialist.•From 10.3% in 2014 up to 18.8% in 2018 of immunocompromised patients were vaccinated against pneumococcus.•From 12.9% in 2014 down to 2.9% in 2018 of people with a chronic medical condition were vaccinated.•43.6% of adults at risk of pneumococcal disease were vaccinated against influenza. The risk of developing pneumococcal infections increases with certain chronic conditions and in immunocompromised patients. We aimed to monitor pneumococcal vaccination coverage in at-risk patients and to examine factors associated with pneumococcal vaccination in France. In this annual cross-sectional study, at-risk patients were extracted between 2014 and 2018 from the National Health Insurance’s (NHI) General scheme’s claims database with their vaccine reimbursements. Descriptive analyses and a logistic model were performed to assess the influence of healthcare use and medical and demographic factors on pneumococcal vaccination. In 2018, 4.5% of 4,045,021 at-risk adults were up to date with their pneumococcal vaccination. During the study period, the number of patients with chronic medical conditions (86% of 4,045,021) increased by 10.1%, but vaccination coverage decreased from 12.9% to 2.9%. The population with immunocompromised status (14% of 4,045,021) increased by 16.2% and vaccination coverage from 10.3% to 18.8%. Influenza vaccination coverage was much higher and stable (around 45.0%). Factors associated with pneumococcal vaccination were: immunocompromised status vs. having a chronic medical condition (odds ratio [OR] 4.72), influenza vaccination (OR 2.36–3.42), hepatitis B vaccination (OR 2.82), DTPolio vaccination (OR 1.52), ≥5 specialist physicians’ visits (OR 1.17), and age above 74 (OR 1.12). Pneumococcal vaccine dispensing was extremely low (median of 9per GP,1per specialist over 9 years) despite frequent healthcare visits. Pneumococcal and influenza vaccination coverage of adults at risk of pneumococcal disease fell well below public health expectations. Invitations for pneumococcal vaccination should be sent by the NHI to high-risk patients. Patient management protocols should include pneumococcal vaccination. Patients with multiple comorbidities are a high-priority population given the large potential health gains offered by pneumococcal vaccination. Commitment of both scientific societies and health authorities is urgently needed to increase vaccination coverage in at-risk populations.

Freemantle et al examine the extent to which the availability of inhaled insulin (INH) affects the perceived acceptability of insulin therapy among patients with type 2 diabetes who failed to achieve target glycemia on current therapy. In this study of theoretical treatment choices among patients with type 2 diabetes failing to achieve target glycemic control on diet and/or oral antidiabetic agent therapy, the availability of INH as a treatment option significantly increased the proportion of patients who would theoretically choose insulin overall.

Background Smoking cessation is a major public health issue. In France, primary care physicians (PCP) are the first contact points for tobacco management. The objective of this study was to understand how PCPs are involved in the management of smoking cessation: ownership, commitment, barriers. Methods A qualitative study was conducted using group and individual semi-structured techniques with PCPs. A thematic analysis of verbatim transcripts was performed to identify concepts and sub-concepts of interest. Saturation was evaluated retrospectively to ensure adequate sample size. Results A sample of 35 PCPs were interviewed, 31 in four focus groups and four in individual interviews. PCPs discussed their roles in the management of tobacco smoking cessation, including the different strategies they are using (e.g., Minimal Intervention Strategy, Motivational Interviewing), the multiple barriers encountered (e.g., lack of time, patients’ resistance to medical advice), the support resources and the treatment and intervention they prescribed (e.g. nicotine replacement therapy, supporting therapist). Conclusions This study provides a better understanding of the beliefs, attitudes, and behaviors of PCPs in managing smoking cessation. Guiding and encouraging patients toward smoking cessation remains a major objective of PCPs. While PCPs reported that progress has been made in recent years in terms of tools, technology and general awareness, they still face major barriers, some of which could be overcome by appropriate training.

Background Even though addressing lifestyle problems is a major recommendation in most guidelines for the treatment of hypertension (HTN), alcohol problems are not routinely addressed in the management of hypertension in primary health care. Methods Internet based survey of 3081 primary care physicians, recruited via the mailing lists of associations for general practitioners (GPs) in France, Germany, Italy, Spain and the UK. Clinical practice, attitudes, knowledge, education and training were assessed. Logistic regression to predict screening, brief intervention and treatment for alcohol dependence in the management of hypertension were assessed. Results Overall, about one third of the interviewed GPs reported sufficient screening in cases with HTN (34.0 %, 95 % confidence interval (CI):32.1-35.8 %). One out of five GPs screened and delivered brief interventions in HTN patients with hazardous consumption (22.2 %, 95 % CI: 20.6-23.8 %) and about one in 13 GPs provided treatment for HTN patients with alcohol dependence other than advice or brief intervention (7.8 %, 95 % CI: 6.8-8.9 %). Post-graduate training and belief in their effectiveness predicted interventions. There were marked differences between countries. Conclusions While current interventions were overall low, marked differences between countries indicate that current practices could be improved. Education and post-graduate training seems to be key in improving clinical practice of including interventions for problematic alcohol consumption and alcohol dependence in primary health care.

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Background Primary care physicians (PCPs) play a key role regarding vaccination in France. The aims of the present study were to define the scoring rules and to assess the measurement properties of the 'Determinants of Intentions to Vaccinate' (DIVA©) questionnaire that aims to assess PCPs' attitudes and beliefs toward vaccination. Methods The DIVA questionnaire was derived from a literature review and PCPs focus groups. Scoring and early validation of the DIVA questionnaire were determined during a cross-sectional study conducted in France. During the study, PCPs had to complete the DIVA questionnaire for any of the six vaccine-preventable diseases (VPDs) to which they were randomly assigned (measles, pertussis, pneumococcus infection, seasonal influenza, human papillomavirus -HPV- infection and tetanus). Descriptive analyses of items and the analysis of the grouping of items into domains were conducted. Internal consistency reliability and construct validity was assessed according to each VPD. Results The DIVA questionnaire was completed by 1,069 PCPs and was well accepted. The 'Commitment of the PCP to the vaccination approach' score showed very good internal consistency reliability (Cronbach's alpha >0.70 overall and for each VPD). The construct validity of the DIVA questionnaire was confirmed. Conclusions The DIVA questionnaire is a valid and reliable measure of PCPs' attitudes and beliefs toward vaccination.