Why Doctor: What does primary health care cover in concrete terms?
Professor Julie Dupouy, coordinator of the F-CRIN “MUST” network
: Primary health care is the first line of care. This is the first contact with the health system for the patient. Typically, these are healthcare professionals in community medicine such as general practitioners, pharmacists, physiotherapists, midwives, nurses, etc. This also includes notions of coordination because these professionals are closest to patients and can therefore create a relationship of continuity and provide them with more personalized care.
Finally, primary care includes the majority of medical care?
Effectively ! White’s square, defined in the 1960s and updated in 2023 by Professor Laporte in the French system, shows that when faced with a health problem, only 5 patients out of 1,000 are hospitalized in a university hospital for a health problem. health.
Primary care research is therefore interesting because it makes it possible to bring together a larger part of the population?
Exactly, research in primary care makes it possible to broaden the characteristics of patients to have research much closer to the general population.
Do you have a concrete example of research to give us?
Several primary care research projects have already been carried out. In particular, there was the Coverage project during the Covid period, which sought to test early treatments against Covid-19. We therefore had to include patients when they had the first signs of Covid, that is to say patients who are not yet in the hospital, so we necessarily had to find them through primary care.
In the short term, what are the objectives of the “MUST” network?
In the short term, the “MUST” network aims to provide the means for primary care research in certain health homes, health centers or experienced medical practices, or primary care teams that already have experience in clinical research. .
Concretely, how is this network deployed?
Three university sites in three regions – Île-de-France, Pays de la Loire and Occitanie – opened in 2024. The idea is to have research staff in these regions who will be deployed in the houses/ health centers to help health professionals carry out research projects. There will be regional and national coordination with other research projects for good project coherence. In 2025, three other university sites will open. There will then be a ramp-up with more and more primary care teams being involved in research projects.
Are research projects necessarily national or can they be international?
Research projects can be national or international. For example, the MUST network will participate in the COLCOT-T2D project proposed by a Canadian team and which will last 3 to 5 years. The aim is to test aspirin and colchicine for primary prevention of cardiac pathologies in type 2 diabetic patients.
How can French patients participate?
It is the general practitioner who will be able to suggest that some of his patients take part. There are some criteria to respect: the patient must therefore be type 2 diabetic, be aged between 55 and 80 years and not have heart problems because we want to study whether aspirin or colchicine, in addition to treatment against diabetes, helps reduce the mortality or morbidity of patients. The trial is randomized, that is to say that the treatment is assigned to the patient by drawing lots, so neither the doctor nor the patient knows whether he is taking aspirin, colchicine or a placebo.
Other projects?
We will certainly launch a project on lung cancer screening because it is a subject that occupies a lot of the scientific community. Some countries have decided to deploy screening for this cancer on a large scale and for the moment there has been no implementation study in France… The network will also rely on another project of scope, the P4DP project: a database project in general medicine via the collection of patient data in medical software, in an anonymized manner, while respecting the GDPR. This will allow us to define the feasibility of such a study, identify patients who can participate, carry out long-term follow-up, etc.
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