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Despite Financial Penalties, French Physicians' Knowledge of Regulatory Practice Guidelines Is Poor
Pierre Durieux, MD, MPH;
Bertrand Gaillac, MD;
Bruno Giraudeau, PhD;
Michel Doumenc, MD;
Philippe Ravaud, MD, PhD
Arch Fam Med. 2000;9:414-418.
Objective To evaluate the level of awareness and knowledge of regulatory practice guidelines (références médicales opposables [RMOs] or regulatory medical references) implemented to control ambulatory care costs among French family physicians.
Design Observational study. Participants were asked to identify RMO topics among a list of actual and fictitious RMO topics and the RMOs themselves among a list of actual and fictitious RMOs.
Setting General practice in France.
Subjects Three hundred twenty-one family physicians.
Main Outcome Measure Average score of 100 (95% confidence interval [CI]) on the awareness of RMO topics and knowledge of the RMOs.
Results The average overall score was 55.8 of 100 (95% CI, 53.3-58.3) for the awareness of the RMO topics and 50.5 (95% CI, 48.3-52.7) for knowledge of the RMOs themselves—53.2 (95% CI, 51.1-55.3) for diagnostic RMOs and 47.8 (95% CI, 45.6-50.0) for therapeutic RMOs. Chance would have yielded an expected mean score of 50. A statistically significant difference was noted between the average score for actual (62.2) and fictitious (43.2) RMOs, P<.001. None of the respondents correctly identified all 24 correct answers.
Conclusion Despite implementation of RMO policy, the awareness and knowledge of RMOs among French family physicians seem weak. The number of RMOs and the difficulties in controlling physicians probably explain these results. Thus, it is doubtful that the RMO policy will have a long-term effect on physicians' behavior.
From the Santé Publique, Faculté de Médecine Broussais Hôtel Dieu, Paris, France (Dr Durieux); Centre de Recherche Clinique, Faculté de Médecine, Tours, France (Dr Giraudeau); Département de Médecine Générale, Centre Hospitalier Universitaire Bicêtre, Le Kremlin Bicêtre, France (Dr Doumenc); and Unité d'Epidémiologie, Hôpital Bichat, Assistance publique-Hôpitaux de Paris (Dr Ravaud). Dr Gaillac is in private practice in Paris.
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