PARIS — The “Dirty Five” of healthcare are regular visitors to the office of a primary care physician: namely, chronic heart failure, ischemic heart disease, asthma, diabetes and chronic obstructive pulmonary disease (COPD). And these five diseases collectively cost 80% of the health expenditure of the 27 member states of the European Union.

A visit to the general practitioner (GP) also is the starting point for patients with cardiovascular risks such as hypertension, respiratory syndromes, metabolic disorders, any of the myriad cancers, infectious diseases, mental disorders such as anxiety and depression, or disabilities and musculoskeletal complaints.

Finally, the GP is the last link in the healthcare chain for patients under palliative care.

Some 4,200 GPs from 33 countries in Europe and another 22 countries in the Middle East and Africa turned out last week for the 13th annual European Congress of General Practice, held here under the umbrella of the World Organization of Family Doctors (WONCA).

The scientific program of 400 presentations covering eight clinical areas playing out in parallel sessions in 15 rooms served as a powerful proof of the ubiquitous role GPs play both upstream and down in the healthcare chain, whether or not that role is recognized as a gatekeeper by a given country’s health insurance fund. Some 1,400 abstracts were submitted, according to the organizers, and several hundred posters presenting results from diverse research and studies conducted across Europe were displayed.

“Rethinking Primary Care in the European Context” was the theme for the conference’s presentations on policy, with an accent on a WONCA initiative to push Europe’s GPs toward evidence-based medicine that stresses a review of best evidence in making decisions about the care of individual patients.

A plenary discussion took on the challenges of thinking differently about recommendations for care including a focus on patients presenting with multiple morbidities.

French general practice organizations took advantage of the pan-European representation at the conference to jointly conduct parallel sessions aimed at inspiring a rethinking of the national model for primary care and to organize a follow-on conference. France’s celebrated healthcare system is facing considerable near-term challenges as budget shortfalls at times clash in the streets with powerful social pressures to do more.

Considering the volume of medical devices used in a primary care practice, the absence of displays by suppliers in the 2,000-square-meter (20,000-square-foot) exhibition area of the congress seemed noteworthy.

But, “not really surprising,” said Cyril Haëntjens, president of Praxiline (Asnières, France), which offers devices for primary care such as stethoscopes, otoscopes, blood pressure monitors and simple penlights.

“Markets are local in Europe,” he said, adding that most GPs place standing orders for disposable materials such as tongue depressors, spatulas and gels. Devices are primarily ordered from catalogs, he said, though his company maintains 2,000 shops, primarily in France.

Praxiline generated €20 million ($28.2 million) in sales in 2006 and is “holding steady for this year,” according to Haëntjens.

The company has distributors throughout France and recently concluded deals for distribution in Greece and Belgium, he said. Later this year he expects to conclude the acquisition of a larger company that manufactures high-volume disposables for primary care, though he declined to name the target.

The newest product from Praxiline is a finger pulse oximeter with color LED display that includes a waveform graphic of the patient’s heart rate. “It is similar to the BCI pulse oximeter from Smith Medical (Watford, UK) that is used in the U.S., but not in Europe,” he said. In addition to measuring blood oxygen saturation and pulse rate, the Praxiline Oxysmart has an added feature to reverse the screen orientation from doctor toward patient.

An unexpected Praxiline product innovation drawing crowds at the congress were its stethoscopes in vivid colors. While the heads and earpieces are the same design as the standard stethoscope with its black tubing, doctors can now choose among nine colors, including pink, teal, neon yellow and lavender, a feature proving to be a marketing bonanza.

“We have never sold so many stethoscopes since we introduced this new line,” Haëntjens said.

Also at WONCA, Adrian Joss, chief executive for United Medical Partners (Bern, Switzerland), presented a new version in a line of cryotherapy devices, hand-held applicators of nitrous oxide used to freeze skin lesions and abnormal growths for removal.

Held like a writing pen, the device combines a gas cartridge with an applicator tip and the innovation of the Cryoalfa Lux model introduced last week is a built-in safety device so that applicator tips can be changed during a procedure.

“There are 50 atmospheres of pressure in the cartridge, and trying to remove the cartridge on current models will send the cartridge through the wall and the tip through the window,” he said, underlining the rationale for the safety feature.

Cryotherapy has been used for prostate and liver cancer, Joss said, but the Cryoalfa line is promoted for quick treatment of growths in gynecology, urology, proctology and some minimally invasive treatments.

The technique has been shown to be effective for a variety of skin diseases, provides high cure rates and good cosmetic results with few contra-indications and a low incidence of complications.

The channel on the tip measures from 20 microns to 80 microns, allowing a precise application to a targeted abnormality of the nitrous oxide. The dermal and epidermal layers of the skin are frozen at minus-128.2 degrees Farhenheit, but not the subsutaneous layer beneath.

The growth can be removed without a destruction of biological function for surrounding tissue, and the procedure causes no bleeding or scar formation. No anesthesia is required.

Application time ranges from two seconds for aging spots up to 12 seconds for condylomes.

“In two to three years, when we have completed some pathological studies we may look at promoting other indications or treatments,” said Joss, adding that there is no competitive model offering the safety feature for changing applicator tips. “We have a very nice patent,” he said.

United also introduced a second product that has been available for two years in Switzerland and is now geared to the wider European market.

The Gynilux is an LED light that snaps on to disposable specula, greatly enhancing visual examination during gynecology procedures.

“We have sold 4,000 units in Switzerland, so we are expecting this product will do well in the European market,” he said.