@article{PAR00019819,
  title = {{G}eneral practitioners who never perform {P}ap smear : the medical offer and the socio-economic context around their office could limit their involvement in cervical cancer screening},
  author = {{M}aj, {C}. and {P}oncet, {L}. and {P}anjo, {H}. and {G}autier, {A}. and {C}hauvin, {P}. and {M}envielle, {G}. and {C}adot, {E}mmanuelle and {R}inga, {V}. and {R}igal, {L}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {I}n {F}rance, with the growing scarcity of gynecologists and a globally low and socially differentiated coverage of cervical cancer screening ({CCS}), general practitioners ({GP}s) are valuable resources to improve screening services for women. {S}till all {GP}s do not perform {P}ap smears. {I}n order to promote this screening among {GP}s, the characteristics of physicians who never perform {CCS} should be more precisely specified. {B}esides already-known individual characteristics, the contextual aspects of the physicians' office, such as gynecologist density in the area, could shape {GP}s gynecological activities. {M}ethods {T}o analyze county (departement) characteristics of {GP}s' office associated with no performance of {CCS}, we used a representative sample of 1063 {F}rench {GP}s conducted in 2009 and we constructed mixed models with two levels, {GP} and county. {R}esults {A}lmost 35% (n = 369) of the {GP}s declared never performing {CCS}. {GP}s working in counties with a poor {GP}-density per inhabitants were more likely to perform {CCS} (odds ratio ({OR}) = 0.52 for each increase of density by 1 {GP} per 10,000 inhabitants, 95% confidence interval ({CI}) = 0.37-0.74). {O}n the contrary, {GP}s working in counties with an easier access to a gynecologist were more likely not to perform {CCS} ({OR} = 1.06 for each increase of density by 1 gynecologist per 100,000 women, 95%{CI} = 1.03-1.10 and {OR} = 2.02 if the first gynecologist is reachable in less than 15 min, 95%{CI} = 1.20-3.41) as well as {GP}s working in areas with a poverty rate above the national average ({OR} = 1.66, 95%{CI} = 1.09-2.54). {T}hese contextual characteristics explain most of the differences between counties concerning rates of not performing {CCS}. {C}onclusions {S}pecific programs should be developed for {GP}s working in contexts unfavorable to their involvement in {CCS}.},
  keywords = {{C}ervical {C}ancer screening ; {G}eneral practitioner ; {P}ap smear ; {D}isparities in healthcare accessibility ; {FRANCE}},
  booktitle = {},
  journal = {{BMC} {F}amily {P}ractice},
  volume = {20},
  numero = {1},
  pages = {art. 114 [10 p.]},
  year = {2019},
  DOI = {10.1186/s12875-019-1004-x},
  URL = {https://www.documentation.ird.fr/hor/{PAR}00019819},
}