Healthcare-seeking behaviour in case of influenza-like illness in the French general population and factors associated with a GP consultation: an observational prospective study

Background GP consultation rates for influenza-like illness (ILI) are poorly known in France and there is a paucity of literature on this topic. In the few articles that have been published, the results are heterogeneous. Aim The aim of the present study was to estimate the proportion of ILI inducing a GP consultation, and to assess its determinants. Design & setting Participants of a French web-based cohort study who reported ≥1 ILI episode between 2012 and 2015 were included. Sociodemographic characteristics, access to health care, and health status variables were collected. Method Healthcare-seeking behaviour was analysed and factors associated with a GP consultation identified using a conditional logistic regression. Results Of the 6023 ILI episodes reported, 1961 (32.6%) led to a GP consultation, with no difference between those at risk of influenza complications and those not (P = 0.42). A GP consultation was more frequent for individuals living in a rural area (odds ratio [OR] = 1.21, 95% confidence interval [CI] = 1.02 to 1.43); those with a lower educational level (OR = 1.43, 95% CI = 1.18 to 1.74); those using the internet to find information about influenza (OR = 1.63, 95% CI = 1.30 to 2.03); patients presenting with worrying symptoms (fever, cough, dyspnoea, sputum, or asthenia); patients having a negative perception of their own health status (OR = 1.51, 95% CI = 1.07 to 2.13; and those having declared a personal doctor (OR = 2.86, 95% CI = 1.72 to 4.76). A GP consultation was less frequent for individuals using alternative medicine (OR = 0.68, 95% CI = 0.58 to 0.78). Conclusion This study allows the identification of specific factors associated with GP consultation for an ILI episode. These findings may help to coordinate health information campaigns and to raise awareness, especially among individuals at risk of influenza complications.


Radiologist
D
partment of Radiology
Institute of Clinical Medicine
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Junior Radiologist
Department of Radiology
Institute of Clinical Medicine
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Junior Radiologist
Department of Radiology
Institute of Clinical Medicine
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

GP, Health Inclusion Clinic
Guy's and St

Thomas' Hospital NHS Foundation Trust
LondonUK

Sorbonne Unive

ite ´s
Epide
iologist

Institut Pierre Louis d'Epide ´miologie et de Sante ´Publique
UPMC Univ Paris 06
INSERM
ParisFrance

Junior Radiologist
Department of Radiology
Institute of Clinical Medicine
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Junior Radiologist
Department of Radiology
Institute of Clinical Medicine
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Junior Radiologist
Department of Radiology
Institute of Clinical Medicine
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Junior Radiologist
Department of Radiology
Institute of Clinical Medicine
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

GP, Health Inclusion Clinic
Guy's and St

Thomas' Hospital NHS Foundation Trust
LondonUK

Sorbonne Universite ´s
Epidemiologist

Institut Pierre Louis d'Epide ´miologie et de Sante ´Publique
UPMC Univ Paris 06
INSERM
ParisFrance

Junior Radiologist
Department of Radiology
Institute of Clinical Medicine
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Junior Radiologist
Department of Radiology
Institute of Clinical Medicine
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Junior Radiologist
Department of Radiology
Institute of Clinical Medicine
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Junior Radiologist
Department of Radiology
Institute of Clinical Medicine
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

GP, Health Inclusion Clinic
Guy's and St

Thomas' Hospital NHS Foundation Trust
LondonUK

Sorbonne Universite ´s
Epidemiologist

Institut Pierre Louis d'Epide ´miologie et de Sante ´Publique
UPMC Univ Paris 06
INSERM
ParisFrance

MDE Besada 
Department of Rheumatology
Institute of Clinical Medicine
Rheumatologist & University Lecturer
University of Tromsø (UiT
The Arctic University of Norway

omsøNorway
Department of Rheumatology
Institute of Clinical Medicine
Rheumatologist & University Lecturer
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Department of Rheumatolo

Institute of
Clinical Medicine
Rheumatologist & University Lecturer
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Department of Rheumatology
Institute of Clinical Medicine
Rheumatologist & University Lecturer
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Sorbonne Universite ´s
Biostatistician

Institut Pierre Louis d'Epide ´miologie et de Sante ´Publique
UPMC Univ Paris 06
INSERM
ParisFrance

Department of Rheumatology
Institute of Clinical Medicine
Rheumatologist & University

cturer
Unive
sity of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Department of Rheumatology
Institute of Clinical Medicine
Rheumatologist & University Lecturer
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Department of Rheumatology
Institute of Clinical Medicine
Rheumatologist & University Lecturer
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Department of Rheumatology
Institute of Clinical Medicine
Rheumatologist & University Lecturer
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Sorbonne Universite ´s
Biostatistician

Institut Pierre Louis d'Epide ´miologie et de Sante ´Publique
UPMC Univ Paris 06
INSERM
ParisFrance

Department of Rheumatology
Institute of Clinical Medicine
Rheumatologist & University Lecturer
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Department of Rheumatology
Institute of Clinical Medicine
Rheumatologist & University Lecturer
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Department of Rheumatology
Institute of Clinical Medicine
Rheumatologist & University Lecturer
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Department of Rheumatology
Institute of Clinical Medicine
Rheumatologist & University Lecturer
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Sorbonne Universite ´s
Biostatistician

Institut Pierre Louis d'Epide ´miologie et de Sante ´Publique
UPMC Univ Paris 06
INSERM
ParisFrance

Department of Rheumatology
Institute of Clinical Medicine
Rheumatologist & University Lecturer
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Department of Rheumatology
Institute of Clinical Medicine
Rheumatologist & University Lecturer
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Department of Rheumatology
Institute of Clinical Medi

ne
Rheumato
ogist & University Lecturer
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Department of Rheumatology
Institute of Clinical Medicine
Rheumatologist & University Lectu

r
University
f Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Sorbonne Universite ´s
Biostatistician

Institut Pierre Louis d'Epide ´miologie et de Sante ´Publique
UPMC Univ Paris 06
INSERM
ParisFrance

BSc, MScGerry Clare 
MBBChir, DTM&H, MA International HealthPolly Nyiri 
Department of General Practice
Institute of Community Medicine
GP & University Lecturer
University of Tromsø
TromsøNorway

Department of General Practice
Institute of Community Medicine
GP & University Lecturer
University of Tromsø
TromsøNorway

D

artment of G
neral Practice
Institute of Community Medicine
GP & University Lecturer
University of Tromsø
TromsøNorway

Department of General Practice
Institute of Community Medicine
GP & University Lecturer
University of Tromsø
TromsøNorway

Western Eye Hospital
LondonUK

Graduate Researcher
Institut Pierre Louis d'Epide ´miologie et de Sante ´Publique
Sorbonne Universite ´s
UPMC Univ Paris 06
INSERM
ParisFrance

MD, MScMatthieu Ariza 
Department of General Practice
Institute of Community Medicine
GP & University Lecturer
University of Tromsø
TromsøNorway

Junior Radiologist
Department of Radiology
Institute of Clinical Medicine
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Department of General Practice
Institute of Community Medicine
GP & University Lecturer
University of Tromsø
TromsøNorway

Junior Radiologist
Department of Radiology
Institute of Clinical Medicine
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Department of General Practice
Institute of Community Medicine
GP & University Lecturer
University of Tromsø
TromsøNorway

Junior Radiologist
Department of Radiology
Institute of Clinical Medicine
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Department of General Practice
Institute of Community Medicine
GP & University Lecturer
University of Tromsø
TromsøNorway

Junior Radiologist
Department of Radiology
Institute of Clinical Medicine
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Western Eye Hospital
LondonUK

GP, Health Inclusion Clinic
Guy's and St

Thomas' Hospital NHS Foundation Trust
LondonUK

Graduate Researcher
Institut Pierre Louis d'Epide ´miologie et de Sante ´Publique
Sorbonne Universite ´s
UPMC Univ Paris 06
INSERM
ParisFrance

Sorbonne Universite ´s
Epidemiologist

Institut Pierre Louis d'Epide ´miologie et de Sante ´Publique
UPMC Univ Paris 06
INSERM
ParisFranc

Guerrisi 
Jun
or Radiologist
Department of Radiology
Institute of Clinical Medicine
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Junior Radiologist
Department of Radiology
Institute of Clinical Medicine
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Junior Radiologist
Department of Radiology
Institute of Clinical Medicine
University of Tromsø (UiT
The Arctic University of Norway

romsøNorwa
Junior Radiologist
Department of Radiology
Institute of Clinical Medicine
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

GP, Health Inclusion Clinic
Guy's and St

Thomas' Hospital NHS Foundation Trust
LondonUK

Sorbonne Universite ´s
Epidemiologist

Institut Pierre Louis d'Epide ´miologie et de Sante ´Publique
UPMC Univ Paris 06
INSERM
ParisFrance

PhDCe ´cile Souty 
Department of Rheumatology
Institute of Clinical Me icine
Rheumatologist & University Lecturer
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Department of Rheumatology
Institute of Clinical Medicine
Rheumatologist & University Lecturer
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Department of Rheumatology
Institut of Clinical Medicine
Rheumatologist & University Lecturer
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Department of Rheumatology
Institute of Clinical Medicine
Rheumatologist & University Lecturer
University of Tromsø (UiT
The Arctic University of Norway
TromsøNorway

Sorbonne Unive site ´s
Biostatistician

Institut Pierre Louis d'Epide ´miologie et de Sante ´Publique
UPMC Univ Paris 06
INSERM
ParisFrance

MD, PhDLouise Rossignol 
Sorbonne Universite ´s
UPMC Univ Paris 06


Insti ut Pierre Louis d'Epide ´miologie et de Sante ´Publique
INSERM
ParisFrance

MD, PhDCle ´ment Turbelin 
Institut Pierre Louis d'Epide ´miologie et de Sante ´Publique
Sorbonne Universite ´s
UPMC Univ Paris 06
INSERM
ParisFrance

MD, PhDThomas Hanslik 
Internist Physician
UFR des Sciences de la Sante ´Simone-Veil
Universite ´de Versailles Saint-Quentin-en-Yvelines
VersaillesFrance

Internist Physician, Service de Me ´decine Interne
Ho ˆpital Ambroise Pare ´
Assistance Publique -Ho ˆpitaux de Paris
APHP
Boulogne-BillancourtFrance

Internist Physician
Sorbonne Universite ´s
UPMC Univ Paris 06


Institut Pierre Louis d'Epide ´miologie et de Sante ´Publique
INSERM
ParisFrance

2016 Receive
: 14 August 2016 Accepted: 16 August 2016 Received: 16 October 2016 Accepted: 04 May 2017ultrasoundgeneral practitionerGPpockettendon ultrasoundgeneral practitionerGPpockettendon ultrasoundgeneral practitionerGPpockettendon ultrasoundgeneral practitionerGPpockettendon influenza-like illnesshealthcare seeking behaviourgeneral populationweb-based studygeneral practice Copyright s
DiscussionTromsø Hospital serves a large area with a population of approximately 160 000.Between 2010-2014 an average of 21 patients per year were referred by their GP for suspected Achilles rupture.

Introduction

The incidence of complete Achilles tendon rupture is 18 per 100 000 patient-years 1 and is usually diagnosed clinically by GPs.The extent of clinical misdiagnosis is unknown in Norway, but may be high. 2This is important as delayed treatment has unfavourable consequences. 1,3We report how a GP, with no clinical ultrasound experience, recorded images with a pocket-sized ultrasound device (PSUD) under supervision to confirm a complete Achilles tendon rupture.This could present a new indication for GP ultrasound.


Case report

A 36-year-old man experienced acute pain above the right heel accompanied by an audible snap while sprinting.He immediately had difficulty walking and 3 hours later consulted an on-call GP.Posterior ankle swelling with a tender depression 3 cm proximal to the calcaneum was found.Active plantar flexion against resistance was weak and Simmonds-Thompson test was 'partially positive' on applying a strong calf-squeeze.Based on these findings, calf muscle rupture was diagnosed as the Achilles tendon was thought to be intact.The patient was advised to elevate the foot and wait 2 weeks for improvement.Two days later a second GP, who was aware of a history of an audible snap, considered complete tendon rupture and reexamined the patient.Findings included an absent right heel raise due to weakness, minimal active plantar flexion against gravity and lying prone, significant right ankle swelling without bruising, and an altered angle of declination.Palpation elicited no ankle bony tenderness, yet a painful gap was identified 6 cm proximal from the calcaneal attachment, along the line of the Achilles tendon.Simmonds-Thompson's test was clearly positive.The positive Simmond's triad indicated a clinical diagnosis of complete rupture of the Achilles tendon.

A 3.4-8 MHz linear array probe PSUD (VScanÔ dual probe, GE Healthcare), set at a depth of 3.5 cm, was used under the supervision of a rheumatologist experienced in ultrasound.The tendon was enlarged from 1 cm to 6 cm above the calcaneal insertion, where a clear gap was seen (Figure 1).Two hours later a radiologist-performed ultrasound (LOGIQ E9Ô, GE Healthcare) and reported an enlarged distal tendon and a complete rupture at 5-6 cm from the calcaneal attachment, creating a 2.7 cm blood-filled gap (Figure 2).Surgical exploration 8 days post-injury found a complete Achilles tendon rupture '5-10 cm above the ankle joint'.


Discussion

Tromsø Hospital serves a large area with a population of approximately 160 000.Between 2010-2014 an average of 21 patients per year were referred by their GP for suspected Achilles rupture.


Introduction

The incidence of complete Achilles tendon rupture is 18 per 100 000 patient-years 1 and is usually diagnosed clinically by GPs.The extent of clinical misdiagnosis is unknown in Norway, but may be high. 2This is important as delayed treatment has unfavourable consequences. 1,3We report how a GP, with no clinical ultrasound experience, recorded images with a pocket-sized ultrasound device (PSUD) under supervision to confirm a complete Achilles tendon rupture.This could present a new indication for GP ultrasound.


Case report

A 36-year-old man experienced acute pain above the right heel accompanied by an audible snap while sprinting.He immediately had difficulty walking and 3 hours later consulted an on-call GP.Posterior ankle swelling with a tender depression 3 cm proximal to the calc

eum was
found.Active plantar flexion against resistance was weak and Simmonds-Thompson test was 'partially positive' on applying a strong calf-squeeze.Based on these findings, calf muscle rupture was diagnosed as the Achilles tendon was thought to be intact.The patient was advised to elevate the foot and wait 2 weeks for improvement.Two days later a second GP, who was aware of a history of an audible snap, considered complete tendon rupture and reexamined the patient.Findings included an absent right heel raise due to weakness, minimal active plantar flexion against gravity and lying prone, significant right ankle swelling without bruising, and an altered angle of declination.Palpation elicited no ankle bony tenderness, yet a painful gap was identified 6 cm proximal from the calcaneal attachment, along the line of the Achilles tendon.Simmonds-Thompson's test was clearly positive.The positive Simmond's triad indicated a clinical diagnosis of complete rupture of the Achilles tendon.

A 3.4-8 MHz linear array probe PSUD (VScanÔ dual probe, GE Healthcare), set at a depth of 3.5 cm, was used under the supervision of a rheumatologist experienced in ultrasound.The tendon was enlarged from 1 cm to 6 cm above the calcaneal insertion, where a clear gap was seen (Figure 1).Two hours later a radiologist-performed ultr sound (LOGIQ E9Ô, GE Healthcare) and reported an enlarged distal tendon and a complete rupture at 5-6 cm from the calcaneal attachment, creating a 2.7 cm blood-filled gap (Figure 2).Surgical exploration 8 days post-injury found a complete Achilles tendon rupture '5-10 cm above the ankle joint'.


Introduction

The incidence of complete Achilles tendon rupture is 18 per 100 000 patient-years 1 and is usually diagnosed clinically by GPs.The extent of clinical misdiagnosis is unknown in Norway, but may be high. 2This is important as delayed treatment has unfavourable consequences. 1,3We report how a GP, with no clinical ultrasound experience, recorded images with a pocket-sized ultrasound device (PSUD) under supervision to confirm a complete Achilles tendon rupture.This could present a new indication for GP ultrasound.


Case report

A 36-year-old man experienced acute pain above the right heel accompanied by an audible snap while sprinting.He immediately had difficulty walking and 3 hours later consulted an on-call GP.Posterior ankle swelling with a tender depression 3 cm proximal to the calcaneum was found.Active plantar flexion against resistance was weak and Simmonds-Thompson test was 'partially positive' on applying a strong calf-squeeze.Based on these findings, calf muscle rupture was diagnosed as the Achilles tendon was thought to be intact.The patient was advised to elevate the foot and wait 2 weeks for improvement.Two days later a second GP, who was aware of a history of an audible snap, considered complete tendon rupture and reexamined the patient.Findings included an absent right heel raise due to weakness, minimal active plantar flexion against gravity and lying prone, significant right ankle swelling without bruising, and an altered angle of declination.Palpation elicited no ankle bony tenderness, yet a painful gap was identified 6 cm proximal from the calcaneal attachment, along the line of the Achilles tendon.Simmonds-Thompson's test was clear y positive.The positive Simmond's triad indicated a clinical diagnosis of complete rupture of the Achilles tendon.

A 3.4-8 MHz linear array probe PSUD (VScanÔ dual probe, GE Healthcare), set at a depth of 3.5 cm, was used under the supervision of a rheumatologist experienced in ultrasound.The tendon was enlarged from 1 cm to 6 cm above the calcaneal insertion, where a clear gap was seen (Figure 1).Two hours later a radiologist-performed ultrasound (LOGIQ E9Ô, GE Healthcare) and reported an enlarged distal tendon and a complete rupture at 5-6 cm from the calcaneal attachment, creating a 2.7 cm blood-filled gap (Figure 2).Surgical exploration 8 days post-injury found a complete Achilles tendon rupture '5-10 cm above the ankle joint'.


Discussion

Tromsø Hospital serves a large area with a population of approximately 160 000.Between 2010-2014

average
of 21 patients per year were referred by their GP for suspected Achilles rupture.


Introduction

The incidence of complete Achilles tendo

rupture is 18 per 100 000 patient-y
ars 1 and is usually diagnosed clinically by GPs.The extent of clinical misdiagnosis is unknown in Norway, but may be high. 2This is important as delayed treatment has unfavourable consequences. 1,3We report how a GP, with no clinical ultrasound experience, recorded images with a pocket-sized ultrasound device (PSUD) under supervision to confirm a complete Achilles tendon rupture.This could present a new indication for GP ultrasound.


Case report

A 36-year-old man experienced acute pain above the right heel accompanied

y an audible snap while sprin
ing.He immediately had difficulty walking and 3 hours later consulted an on-call GP.Posterior ankle swelling

th a tender depression 3
cm proximal to the calcaneum was found.Active plantar flexion against resistance was weak and Simmonds-Thompson test was 'partially positive' on applying a strong calf-squeeze.Based on these findings, calf muscle rupture was diagnosed as the Achilles tendon was thought to be intact.The patient was advised to elevate the foot and wait 2 weeks for improvement.Two days later a second GP, who was aware of a history of an audible snap, considered complete tendon rupture and reexamined the patient.Findings included an absent right heel raise due to weakness, minimal active plantar flexion against gravity and lying prone, significant right ankle swelling without bruising, and an altered angle of declination.Palpation elicited no ankle bony tenderness, yet a painful gap was identified 6 cm proximal from the calcaneal attachment, alo g the line of the Achilles tendon.Simmonds-Thompson's test was clearly positive.The positive Simmond's triad indicated a clinical diagnosis of complete rupture of the Achilles tendon.

A 3.4-8 MHz linear array probe PSUD (VScanÔ dual probe, GE Healthcare), set at a depth of 3.5 cm, was used under the supervision of a rheumatologist experienced in ultrasound.The tendon was enlarged from 1 cm to 6 cm above the calcaneal insertion, where a clear gap was seen (Figure 1).Two hours later a radiologist-performed ultrasound (LOGIQ E9Ô, GE Healthcare) and reported an enlarged distal tendon and a complete rupture at 5-6 cm from the calcaneal attachment, creating a 2.7 cm blood-filled gap (Figure 2).Surgical exploration 8 days post-injury found a complete Achilles tendon rupture '5-10 cm above the ankle joint'.


Discussion

Tromsø Hospital serves a large area with a population of approximately 160 000.Between 2010-2014 an average of 21 patients per year were referred by their GP for suspected Achilles rupture.


Introduction

Last summer our small medical team visited the Calais 'Jungle'.Since tha

time much has chang
d and the camp is being demolished and by the time this article is read, it will probably be long gone.Some youngsters are finally being brought to the UK under the 'Dubs' amendment.However, once this camp is cleared it will not solve

e ongoing flight of refuge
s from war torn areas: other camps are already appearing.


July 2016

A young Afghan man caught his finger on a sharp point while trying to cross a barbed wire fence.The finger was partially degloved.He attended the local hospital, where they placed a few sutures, but now, 2 weeks later, the skin is necrotic and the underlying tissue looks infected.He is in danger of losing his finger.

A middle-aged Sudanese man has been having rigors and is generally unwell.He says it is similar to when he last had malaria.

A young Ukrainian woman complains of lower back pain and urinary frequency.The paths of these three people may never have crossed; yet here they are, denizens of the Calais Jungle.They turn up to a makeshift primary care 'clinic' that we set up in the heart of the unofficial refugee camp one weekend in July 2016.

With only

sic medical supplies, we are immedia
ely challenged by what we see.How can we arrange secondary care for the young Afghan in danger of losing his finger?We try to persuade him to return to the original local hospital, but he is reluctant.It was not a good experience for him the first time round.

With the other two patients, it is easier.They can attend the Salam clinic run by a local association during weekdays.Later, we receive word that malaria has been confirmed in our Sudanese patient.

More people arrive, presenting with scabies, rat bites, tinea, chest infections, and wheezing from inhaling smoke from fires lit to cook and keep warm in their tents at night.We examine a severely malnourished 2-year-old boy.We meet several of the camp's 600 unaccompanied children, at grave risk of sexual exploitation.We learn that there is inadequate safeguarding in place to protect them.A young Eritrean man comes in worried about his eye.He has sustained direct ocular trauma from a rubber bullet, and will never see normally again out of that eye.We see haematomas from police batons, and hear about children being exposed to tear gas again and again (Figure 1).


The reality

These are no ordinary patients.They have travelled far from home to escape war, poverty, and misery.They have endured personal odysseys to get here, experienced untold hardships, and suffered unimaginable privations.Many have survived the loss of their families, torture, and rape.Their journeys over, for the moment at least, they must make their homes in the Calais Jungle.Their new shelters are in many cases mere tarpaulin covers, and their new beds just rugs on the ground.They own next to nothing.There is little for them to do, besides use their ingenuity to cross the English Channel in search of a better life.They are vulnerable to exploitation, crime, injury, and disease.Potentially violent clashes with local police, with other ethnic groups resident in the Jungle, or local far Results: Of the 6023 ILI episodes reported, 1961 (32.6%) led to a GP consultation, with no difference between those at risk of influenza complications and those not (P = 0.42).A GP consultation was more frequent for individuals living in a rural area (odds ratio [OR] = 1.21, 95% confidence interval [CI] = 1.02 to 1.43); those with a lower educational level (OR = 1.43, 95% CI = 1.18 to 1.74); those using the internet to find information about influenza (OR = 1.63, 95% CI = 1.30 to 2.03); patients presenting with worrying symptoms (fever, cough, dyspnoea, sputum, or asthenia); patients having a negative perception of their own health status (OR = 1.51, 95% CI = 1.07 to 2.13; and those having declared a personal doctor (OR = 2.86, 95% CI = 1.72 to 4.76).A GP consultation was less frequent for individuals using alternative medicine (OR = 0.68, 95% CI = 0.58 to 0.78).


Introduction

Each year in France, between 700 000 and 4.8 million individuals consult their GP for ILI, represen ing 1-8% of the French population. 1,2Although recovery is generally rapid, influenza can cause serious complications, especially in those aged >65 years old, pregnant women, individuals with chronic illnesses, or obesity. 3,4Mortality due to influenza during seasonal epidemics is estimated in France to be 1620-11 400 deaths per year, 5 and in the world 250 000-500 000 deaths per year. 6nfluenza epidemiological surveillance is traditionally carried out by health professionals, organised in national networks (such as the French Sentinelles network 7 or the Italian Influenza Surveillance network 8 ), and brought together under the coordination of the World Health Organization (WHO) in the Global Influenza Surveillance and Response System (GISRS).9 However some patients with ILI do not seek medical care and are not taken into account in these national networks, leading to an underestimation of the ILI rate among the general population.Cohort studies are thus needed to estimate this proportion of patients who do not seek medical care in case of ILI. 10 Several different results have been obtained reflecting the proportion of patients who do seek medical care in case of ILI, ranging from 4% in an Italian internet-based study up to 85% in an Israeli phone survey.10- 16 Such disparities can be explained by the heterogeneity of social security systems among the analysed countries, different study designs, and different ILI definitions.In France, only two studies have been conducted on this topic. Thefirst one was conducted on households which were recruited when one member made a visit to a GP for ILI, and the second study was performed during the A (H1N1)pdm09 influenza pandemic.The proportions of GP consultations for ILI were estimated to be 57% and 62%, respectively.17,18 However, these findings cannot be extrapolated to the general population during a seasonal influenza epidemic because of the specific conditions under which they were performed: the first with a focus on a s

cific subgroup, and the second during a
influenza pandemic.Moreover, evaluation of healthcare-seeking behaviour in specific groups of individuals, such as those at risk of influenza complications, was not performed. I is important to know if these individuals consult a GP and benefit effectively from an antiviral treatment in case of recommendation.Neuraminidase inhibitor treatment is recommended as soon as possible by French public health authorities, 19 as in most other countries, 20,21 for patients with ILI who: a) are at risk of influenza complications (defined as patients with 1 of the following characteristics: age 65 years, underlying c ronic disease, obesity [defined as BMI 40 kg/m 2 ], or pregnancy); b) are hospitalised; or c) have severe, complicated, or progressive illness.Currently only neuraminidase inhibitors (oseltamivir and zanamivir) may be prescribed; amandatanes are no longer recommended because of viral resistance.22 Characterising healthcare-seeking behaviour even further is important in order to identify the barriers to GP consultations in case of ILI, and to improve information campaigns and healthcare accessibility.A random-digit-dialling phone survey in the US has shown that GP consultation is associated with female sex, age >65 years, chronic illness, having a health insurance, and reporting a personal doctor.13,14 No factor was significantly associated with GP consultation in an Israeli study.12 Overall, outside the ILI context, a review of the international literature has shown that the choice to consult a physician is influenced by various factors linked to economical, sociodemographic, health condition, behavioural, or geographic characteristics.23 The objectives of this study were to characterise healthcare-seeking behaviour for ILI amon

the general popul
tion in France, and to analyse the associated factors.


Method

This observational prospective study is based on data from the web-based GrippeNet.frcohort study (www.grippenet.fr).GrippeNet.frwas implemented in France in January 2012 by the French National Instit

e for Healt
and Medical Research (Inserm), Pierre and M