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Additional file 1. Additional methods and results.

Modèle dominant actuel de la Médecine dans bon nombre de pays au monde, l’«Evidence Based Medicine » (EBM), dénommée ainsi, par Gordon Guyatt en 1992, a été difficilement traduite en français. On parlera surtout de Médecine fondée sur les preuves. Apparue au Canada, dans le sillage de l’épidémiologie clinique, l’EBM a été développée et promue tout d’abord comme outil d’apprentissage de la Médecine par le groupe de travail international « Evidence based working group ». Il s’agissait alors de procurer aux étudiants un outil capable de distinguer les études probantes au sein d’une littérature médicale qui commençait à foisonner et de développer du même coup leur esprit critique à partir des articles scientifiques (sources primaires d’information). Mais l’EBM est bien vite devenue la théorie d’une pratique, une façon d’exercer la médecine clinique. On est ainsi passé rapidement d’une méthode de tri de la littérature médicale « scientifique » selon un certain niveau de preuve, à l’exploitation des résultats des études issues de ce tri (source secondaire d’information) : revues systématiques de la littérature, recommandations de bonne pratique et autres documents en vue d'améliorer les décisions cliniques mais aussi en tant qu'instruments de régulation des pratiques, des produits et des actes.

Objectives To describe and compare patients seeking treatment for sleep, anxiety and depressive disorders (SADD) from physicians in general practice (GPs) with three different practice preferences: strictly conventional medicine (GP-CM), mixed complementary and conventional medicine (GP-Mx) and certified homeopathic physicians (GP-Ho). Design and setting The EPI3 survey was a nationwide, observational study of a representative sample of GPs and their patients, conducted in France between March 2007 and July 2008. Participants 1572 patients diagnosed with SADD. Primary and secondary outcomes The patients’ attitude towards complementary and alternative medicine; psychotropic drug utilisation. Results Compared to patients attending GP-CM, GP-Ho patients had healthier lifestyles while GP-Mx patients showed similar profiles. Psychotropic drugs were more likely to be prescribed by GP-CM (64%) than GP-Mx (55.4%) and GP-Ho (31.2%). The three groups of patients shared similar SADD severity. Conclusion Our results showed that patients with SADD, while differing principally in their sociodemographic profiles and conventional psychotropic prescriptions, were actually rather similar regarding the severity of SADD in terms of comorbidities and quality of life. This information may help to better plan resource allocation and management of these common health problems in primary care.

Objective To assess the burden of diseases and quality of life (QOL) of patients for a large variety of diseases within general practice. Design In a representative nationwide cross-sectional study, a total of 825 general practitioners (GPs) were randomly selected from across France. Independent investigators recruited 8559 patients attending the GPs' practices. Data on QOL (12-Item Short Form questionnaire) and other individual characteristics were documented by the independent investigators for all participants in the waiting room. Medical information was recorded by GPs. Sampling was calibrated to national standards using the CALMAR (CALage sur MARges) weighting procedure. Associations of lower scores (ie, below vs above the first quartile) of physical and mental component scores (physical component summary score (PCS) and mental component summary score (MCS), respectively) with main diseases and patients characteristics were estimated using multivariate logistic regression. Weighted morbidity rates, PCS and MCS were computed for 100 diagnoses using the International Classification of Diseases (9th version). Results Overall mental impairment was observed among patients in primary care with an average MCS of 41.5 (SD 8.6), ranging from 33.0 for depressive disorders to 45.3 for patients exhibiting fractures or sprains. Musculoskeletal diseases were found to have the most pronounced effect on impaired physical health (OR=2.31; 95% CI 2.08 to 2.57) with the lowest PCS (45.6 (SD 8.8)) and ranked first (29.0%) among main diagnoses experienced by patients followed by cardiovascular diseases (26.7%) and psychological disorders (22.0%). When combining both prevalence and QOL, musculoskeletal diseases represented the heaviest burden in general practice. Conclusions Etude épidémiologique de l'Impact de santé public sur 3 groupes de pathologies (EPI3) is the first study to provide reference figures for burden of disease in general practice across a wide range of morbidities, particularly valuable for health-economics and healthcare-system evaluation., Article summary Article focus The impact of diseases on quality of life (QOL) in general practice has been assessed among selected samples of patients, usually from studies including a limited number of medical practices and/or focusing mainly on chronic conditions. There is a clear need for more data on QOL of patients in primary care; the aim of the Etude épidémiologique de l'Impact de santé public sur 3 groupes de pathologies (EPI3) survey was to provide reference figures for disease burden in this setting. Key messages The EPI3 study was a cross-sectional survey combining unique data from patients and general practitioners (GPs), and allowed provision of reference figures for the vast majority of diseases encountered in primary care for a large number of patients. The study highlighted the burden of musculoskeletal and psychological disorders, experienced by more than half the patients. Although social and medical determinants of patients' QOL were somewhat similar than those found in previous studies in primary care, the EPI3 survey showed more pronounced mental impairment in French patients. Strengths and limitations of this study No nationwide study on burden of disease combining both prevalence measures and QOL assessment has been conducted to date, addressing such a large variety of diseases in general practice. On-site selection and recruitment by an independent investigator limited the possibility of selection bias among patients, and the participation of physicians added high specificity to medical data collection. A study design providing a high specificity in data collection led to a relatively low response rate from GPs. However, stratified recruitment phases and sample sizes from both GPs and patients highly representative of national standards ensured the strong external validity of the results. Home consultations, which are common among GPs in France, were not surveyed which could have led to an underestimation of the burden of disease.