French general practitioners (GPs) refer their patients with major depression to psychiatrists or for psychotherapy at particularly low rates. This qualitative study aims to explore general practitioners' (GP) opinions about psychotherapy, their relationships with mental health professionals, their perceptions of their role and that of psychiatrists in treating depression, and the relations between these factors and the GPs' strategies for managing depression. In 2011, in-depth interviews based on a semi-structured interview guide were conducted with 32 GPs practicing in southeastern France. Verbatim transcripts were examined by analyzing their thematic content. We identified three profiles of physicians according to their opinions and practices about treatment strategies for depression: pro-pharmacological treatment, pro-psychotherapy and those with mixed practices. Most participants considered their relationships with psychiatrists unsatisfactory, would like more and better collaboration with them and shared the same concept of management in general practice. This concept was based both on the values and principles of practice shared by GPs and on their strong differentiation of their management practices from those of psychiatrists, Several attitudes and values common to GPs might contribute to their low rate of referrals for psychotherapy in France: strong occupational identity, substantial variations in GPs' attitudes and practices regarding depression treatment strategies, representations sometimes unfavorable toward psychiatrists. Actions to develop a common culture and improve cooperation between GPs and psychiatrists are essential. They include systems of collaborative care and the development of interdisciplinary training common to GPs and psychiatrists practicing in the same area.

Context: The shortage of general practitioners (GPs) is a growing concern in Europe, especially in France. This problem is likely to continue until the end of the 2020s. Objectives: To study the GPs’ perceptions of access to care in medically underserved areas (i.e. with low physician density), its consequences on their working conditions, and how they cope with the resulting difficulties. Methods: Semi-structured individual interviews were conducted between May and August 2021 of 29 GPs practising in areas of southeastern France with a low physician density or at risk of a doctor shortage. Purposive sampling was used to include profiles of diverse physicians and diverse rural and urban areas. The interviews, conducted with an interview guide, were transcribed and analysed thematically. Results: The participants described a serious degradation of access to care in their areas. These issues also concerned urban areas, where they were, according to the participants, underrecognized. The participants’ workloads were rising, at a rate often perceived as unsustainable: many participants, including the youngest group, reported they were exhausted. Their principal source of dissatisfaction was their impression that they could not do their work correctly. Participants reported that these difficulties required them to improvise and adapt without any official or formal method to keep their practice manageable. Conclusion: These GPs were worried about the future of their profession and their patients. They expected strong measures by public policymakers and officials, but paradoxically seemed to have little interest in the solutions these officials are promoting.

We conducted a qualitative survey of 20 occupational physicians (OPs) in southeastern France in 2008 to study their attitudes and practices regarding the prevention of occupational cancers. Occupational physicians' practices regarding occupational cancers centered mainly on prevention. Numerous difficulties impeded these activities: attitudes that minimized the carcinogenic risks by employers and employees, the absence or inadequacy of mandatory risk assessment to identify health hazards, and difficulties in obtaining individual exposure forms, which employers are supposed to complete to identify employees exposed to carcinogens. Other problems were related to the resources available to OPs and the constraints on their time. Finally, some OPs reported that they lacked self-efficacy. The results of this study suggested the need to strengthen OPs' initial training, draft and adopt good practice guidelines for various aspects of their practices, and improve collaborations between OPs and other professionals specialized in the prevention of occupational risks.

We assessed general practitioners’ (GPs) choices when starting treatment for major depression in a cross-sectional case-vignette survey implemented in 2011 within the parameters of an existing panel of randomly selected GPs (n=2 114 ; one national and three regional samples). Most GPs had a favourable opinion regarding the efficacy of psychotherapy in depression but they stressed several barriers in order to access this type of treatment. GPs rarely recommended psychotherapy alone. Two thirds of GPs proposed antidepressants and, among them about 50% proposed to refer the patient for psychotherapy. Treatment choices were associated with patients’ socio-demographic characteristics and GPs’ personal rather than professional characteristics.

Issue/Problem: Despite high medical densities in Southeastern France, access to prevention and care is difficult in some territories due to a lack of health professionals. The Regional Council supports multidisciplinary group practices (MGP) to improve primary care access and quality. When developing them, health professionals have to propose a health project addressing population health needs in the area. Description of the problem: Two complementary resource centres -the Southeastern Regional Health Observatory and the Regional Committee for Health Education- collaborate to provide support to health professionals in the creation of MGP. The process includes a territorial assessment based on quantitative indicators about various environmental and socio-economic determinants, morbidity, mortality, and health-seeking behaviours. Stakeholders then discuss the results of this assessment in order to confront it to their experiences, identify priorities and design the health project: it defines the forms according to which professionals will work together and set specific objectives and activities to cover main public health needs in the corresponding territory. Results: Since 2011, our methodological support has benefited 45 MGP projects: 19 were successful, 13 are still in progress and 13 projects were not completed. It helped decision-makers in the identification of priority territories in terms of prevention and care; it also presented outlooks of the current and coming health needs of various areas. Lessons: Levers to the MGP setting up have been identified: a project is more successful when it is initiated by health professionals supported by local authorities, and up for discussion. On the contrary, preconceived ideas about the MGP project complicate the assessment’s appropriation. Key messages: Taking into account the results of the assessment helps to propose MGP projects that better match population needs. It also improves collective knowledge of public health issues between health professionals and various local stakeholders.