22 research outputs found
Entre reconnaissance des savoirs expĂ©rientiels des malades et coopĂ©rations rĂ©flexives collectives : un point dâĂ©tape bibliomĂ©trique
International audienceThe discourse on patient participation and cooperation development between health professionals and users are increasing at present. They suggest that our health systems are in transition between two eras: the first was that of the recognition of the experiential knowledge of patients; the second, announced as imminent, would be that of a systematization of reflexive cooperation of all types between patients, groups of patients and professionals. Through bibliographic and bibliometric analyzes in biomedical publications, this article aims to objectify this intermediate situation. Three investigations are deployed for this purpose : (1) identification of publications indexed by the keywords âparticipationâ, âinvolvementâ and âengagementâ in PubMed biomedical bibliographic database; (2) their meta-analysis showing the relationships between these terms and others also close to the idea of reflexive cooperation; (3) a lexical analysis of these publications using a corpus gradually expanded to a file of the French School of Advanced Studies in Public Health (EHESP) and contents of the Journal of Participatory Medicine, to compensate for the virtual absence of publications on collective cooperation.Les discours sur la participation des patients et sur le dĂ©veloppement des coopĂ©rations entre usagers de la santĂ© et professionnels se multiplient Ă lâheure actuelle. Ils suggĂšrent que nos systĂšmes de santĂ© sont en transition entre deux Ă©poques : la premiĂšre a Ă©tĂ© celle de la reconnaissance des savoirs expĂ©rientiels des malades ; la seconde, annoncĂ©e comme imminente, serait celle dâune systĂ©matisation descoopĂ©rations rĂ©flexives de tous types entre malades, groupes de malades et professionnels. Par des analyses bibliomĂ©triques des termes concernant la « participation des patients » dans les publications biomĂ©dicales, cet article vise Ă objectiver cette situation intermĂ©diaire. Trois investigations sont dĂ©ployĂ©es dans ce but : le repĂ©rage des publications indexĂ©es par les mots-clĂ©s « participation », « involvement » et « engagement » dans la base de donnĂ©es bibliographique biomĂ©dicale PubMed ; leur mĂ©taÂanalyse montrant les relations entre ces termes et dâautres Ă©galement proches de lâidĂ©e des coopĂ©rations rĂ©flexives ; une analyse lexicale de ces publications Ă partir dâun corpus progressivement Ă©largi Ă un dossier de lâĂcole des hautes Ă©tudes en santĂ© publique (ĂHĂSP) et Ă des contenus du Journal of Participatory Medicine
Patients with chronic lung disease and pharmacists : identification and modeling knowledge exchange
Dans une pĂ©riode marquĂ©e par un bouleversement des systĂšmes dâinformation et de santĂ© et de la place de la maladie dans la sociĂ©tĂ©, la question du rapport au savoir en santĂ© devient essentielle. La relation soignant-soignĂ©, anciennement vĂ©cue sur un mode passif, est aujourdâhui un Ă©change actif de savoirs entre deux individus et deux mondes sociaux, partenaires. Ces constats remettent en cause les rapports soignant-soignĂ©, entre savoir savant et savoir profane, et les modĂšles de pratiques existants. En alliant les atouts des sciences de lâĂ©ducation Ă celles des modĂ©lisations mathĂ©matiques, nous avons caractĂ©risĂ© comment les patients atteints dâasthme ou dâhypertension artĂ©rielle pulmonaire Ă©changeaient de lâinformation et des savoirs avec les pharmaciens de ville et hospitaliers. La mĂ©thodologie gĂ©nĂ©rale faisait appel Ă la stratĂ©gie de triangulation et se divisait en 4 parties : une analyse de la littĂ©rature, un remue-mĂ©ninges, une analyse de contenu de 39 entretiens semi-dirigĂ©s, une Ă©tude statistique utilisant lâanalyse des correspondances simples basĂ©e sur un questionnaire diffusĂ© Ă 124 patients. La nature de lâĂ©change de savoirs (ES) Ă©tait composĂ©e de 3 dimensions interdĂ©pendantes que nous avons modĂ©lisĂ©e : « ModĂšle 3 C : cure, care et coordination ». LâintensitĂ© et la nature de lâES variaient selon le type de pharmacien impliquĂ©, la maladie, sa durĂ©e, son grade de sĂ©vĂ©ritĂ©, lâĂąge, le niveau dâapprenance, les reprĂ©sentations des patients vis-Ă -vis des pharmaciens et des mĂ©dicaments. Le partenariat avec les professionnels de santĂ©, le patient et les aidants, constituait une composante indispensable et facilitatrice de lâES. LâES contribuait Ă lâautoformation des patients pour acquĂ©rir des compĂ©tences dâautosoins et mieux gĂ©rer leur maladie chronique et ses impacts. Nous avons mis en Ă©vidence que le pharmacien sâapparentait Ă un facilitateur de lâautoformation des patients, de lâĂ©ducation diffuse et du bricolage des savoirs ; la pharmacie, officinale ou hospitaliĂšre constituait lâembryon dâun tiers-lieu.In this period of change characterized by a disruption of information and health systems, the relationship issue of knowledge becomes more essential. The healthcare professional-patient relationship, formerly based on a passive mode, has become an active exchange of knowledge between two individuals and two social worlds, seen as partners. These observations challenge the healthcare professional -patient relationship, between scholar and lay knowledge, and existing practice models. Combining the strengths of Education Sciences to those of mathematical modeling, this work allows us accurately characterizing how patients with asthma or pulmonary arterial hypertension shared information and knowledge with both community and hospital pharmacists. This study uses a triangulation strategy and combines 4 parts: a literature analysis, a brainstorming, a content analysis of 39 semi-directed interviews and a correspondance analysis based on a questionnaire submitted to 124 patients. The nature of knowledge exchange consisted in 3 interrelated dimensions that we modeled : â3C Model: Cure, Care and Coordinationâ. The exchange intensity and nature varied with the type of pharmacist involved, the pathology, the severity and disease duration, the patient age, the knowledge level. The patient representations towards pharmacists and medicine also influenced the nature. We identified that the partnership between healthcare professionals, patients and caregivers was a fundamental component and a facilitator of knowledge exchange. We found that the knowledge exchange contributed to the self-training of patient to acquire self-care skills and better manage their chronic disease and its impacts. Finally, this study allowed highlighting (1) the pharmacist was a facilitator of patients selftraining, diffuse education and self-made knowledge; (2) the community and hospital pharmacies were the location where all these take place, as a third place
Parcours de soins des patients traitĂ©s par anticancĂ©reux oraux (analyse des risques et interĂȘts de la mise en Ćuvre d'un outil d'e-learning)
PARIS-BIUP (751062107) / SudocSudocFranceF
DĂ©ploiement de la dĂ©mocratie sanitaire : point dâĂ©tape et typologie de la prise en considĂ©ration de la rĂ©flexivitĂ© collective des malades et autres personnes concernĂ©es (Version longue, texte mis Ă jour en Mars 2018)
International audienceContext: There is now a proliferation of discourses on the development of health democracy based on the deployment of situations or cooperation mechanisms associating patients and relatives with multiple health professionals. Objective: Beyond these general discourses, how can we specify the nature and place of reflexivity - particularly collective - of patients and their families today? In response, this contribution aims to provide a means of reporting (now and in the coming years) on situations that can be described as "collective reflective cooperation" (CRC). This term refers to situations in which patients and concerned persons co-develop shared knowledge together, which may for example concern the construction and management of their therapies. Method: The work is based on two complementary works: bibliometric studies in the international PubMed database based on engagement, involvement and participation and the construction of a typology based on levels of reflexivity. Results: In the PubMed medical bibliographic database, the number of studies mentioning patient engagement is increasing, but refers almost exclusively to individual cooperation, aimed at better compliance through a form of empowerment or consideration as part of a patient-centred process to improve the ergonomics of treatments; this growth is increasingly linked with e-Health or mobile health tools. In fact, even if there are CRC cases concerning the representation of uses, education and mediation or even therapies, they are only very rarely visible in PubMed. Conclusion: The sharing of a typology of protocols based on the characteristics of relationships with patients (individual or collective, high or low reflexivity) becomes essential to the study of the progress of health democracy. Already, the creation of a first typology allows a double observation: on the one hand, we observe today CRC with high use of patients' reflexivity only in the rare cases where the opportunity to synchronize and synergize individual reflexivities is offered; on the other hand, this occurs only when a group of patients - motivated by the absence of an effective medical therapeutic solution - allows it.On observe aujourd'hui une multiplication des discours sur le dĂ©veloppement de la dĂ©mocratie sanitaire appuyĂ©e sur le dĂ©ploiement de situations ou dispositifs de coopĂ©rations associant malades et proches aux multiples professionnels de santĂ©. Objectif : Au-delĂ de ces discours gĂ©nĂ©raux, comment prĂ©ciser la nature et la place qu'occupe aujourd'hui la rĂ©flexivitĂ©-en particulier collective-des malades et proches ? En rĂ©ponse, cette contribution vise Ă fournir le moyen de rendre compte (aujourd'hui puis au fur et Ă mesure dans les annĂ©es qui viennent) de situations qualifiables de « coopĂ©rations rĂ©flexives collectives » (CRC). Ce terme dĂ©signe des situations dans lesquelles les malades et personnes concernĂ©es co-Ă©laborent ensemble des savoirs partagĂ©s, pouvant par exemple concerner la construction et la gestion de leurs thĂ©rapeutiques. MĂ©thode : Le travail s'appuie sur deux travaux complĂ©mentaires : des Ă©tudes bibliomĂ©triques dans la base internationale PubMed partant de l'engagement, l'implication et la participation puis la construction d'une typologie fondĂ©e sur les niveaux de rĂ©flexivitĂ©. RĂ©sultats : Dans la base bibliographique mĂ©dicale PubMed, les travaux mentionnant l'engagement des patients se multiplient, mais se rĂ©fĂšrent quasi exclusivement Ă des coopĂ©rations individuelles, visant une meilleure observance via une forme d'empowement ou la prise en compte dans le cadre d'un processus patient-centrĂ© d'amĂ©lioration de l'ergonomie des traitements ; cette croissance se trouve de plus en plus liĂ© avec les outils de la e-Health ou de la santĂ© mobile. De fait, mĂȘme si des cas de CRC Ă propos de la reprĂ©sentation des usages, de l'Ă©ducation et de la mĂ©diation ou mĂȘme des thĂ©rapeutiques existent, celles-ci ne sont que trĂšs peu visibles dans PubMed. Conclusion : Le partage d'une typologie des protocoles fondĂ©e sur les caractĂ©ristiques des relations aux malades (individuelles ou collectives, haute ou basse rĂ©flexivitĂ©) devient indispensable Ă l'Ă©tude des progrĂšs de la dĂ©mocratie sanitaire. D'ores et dĂ©jĂ , la crĂ©ation d'une premiĂšre typologie permet un double constat : d'une part, on n'observe aujourd'hui de CRC Ă fort usage de la rĂ©flexivitĂ© des malades que dans les rares cas oĂč est offerte l'opportunitĂ© de la synchronisation et de la mise en synergie des rĂ©flexivitĂ©s individuelles ; d'autre part, ceci ne se produit que lorsqu'un collectif de malades-motivĂ© par l'absence de solution thĂ©rapeutique mĂ©dicale efficace-le permet
Processus décisionnel relatif aux activités pharmaceutiques : simulation avec des pharmaciens gestionnaires en pharmacie au Québec
RĂ©sumĂ© Objectif : Lâobjectif principal consistait a evaluer, lors dâun exercice de simulation, lâuniformite de la hierarchisation des activites pharmaceutiques entre six equipes de pharmaciens gestionnaires en pharmacie quebecois. Lâobjectif secondaire visait a comparer les resultats de cette activite de simulation avec un exercice semblable realise precedemment avec un groupe de pharmaciens gestionnaires a lâechelle du Canada. Lâobjectif tertiaire consistait a determiner les facteurs ayant influence la prise de decision individuelle et par equipe. Description de la problĂ©matique : Il existe peu de donnees relatives aux processus decisionnels utilises par les pharmaciens gestionnaires. Une simulation de hierarchisation des activites pharmaceutiques sâest deroulee en septembre 2011 aupres de 31 pharmaciens gestionnaires repartis en six equipes. Les equipes ont choisi de couvrir de 23 a 28 des 32 activites proposees. Discussion : En comparaison avec une simulation similaire realisee aupres de gestionnaires au niveau du Canada, les participants quebecois accordaient un poids relatif plus eleve au domaine de la distribution (29 % c. 24 %), un peu moins a lâenseignement (11 % c. 16 %) et a la gestion (19 % c. 21 %), mais similaire a la clinique (35 % c. 34 %). Un ecart plus important apparaissait quant au choix de la couverture de chacune des activites pharmaceutiques. Le classement individuel des facteurs ayant influence la hierarchisation des activites pharmaceutiques etait similaire au classement realise par equipe, a lâexception de trois facteurs. Le classement dâau moins six facteurs dâinfluence etait different entre les participants quebecois et canadiens. Conclusion : Cette simulation a mis en evidence le poids relatif accorde aux differents secteurs dâactivites pharmaceutiques ainsi que les facteurs ayant une influence sur le processus decisionnel. Dâautres etudes seront necessaires afin de comprendre la hierarchisation des facteurs influencant la prise de decision des pharmaciens gestionnaires. Abstract Objective: The main objective was during a simulation exercise to evaluate the uniformity of pharmacy activity and service prioritization among six teams of Quebec pharmacy managers. A secondary objective was to compare the results of this simulation activity with one previously done with a group of pharmacy managers from the rest of Canada. A third objective was to determine the factors influencing individual and group decision making. Problem Description: Few data exist regarding the decisional processes used by pharmacy managers. In September 2011, a simulation of the prioritization of pharmacy activities and services was performed with 31 pharmacy managers divided into six teams. The teams chose to cover 23â28 of the 32 proposed activities. Discussion: In comparison with a previous simulation done with managers from the rest of Canada, Quebec participants attributed a greater weight to distribution activities (29% vs 24%), slightly less to teaching (19% vs 21%) but similar weight to clinical activities (35% vs 34%). A more significant deviation was observed with respect to coverage of each pharmacy activity. The classification of factors influencing the prioritization of pharmacy activities and services by individuals was similar to that obtained by teams, with the exception of three factors. The ranking of at least six influential factors differed in Quebec and Canadian participants. Conclusion: This simulation exercise highlighted the relative weight attributed to the different sectors of pharmacy activities and services in addition to the factors influencing the decisional process. Other studies are necessary to understand the prioritization of factors influencing decision making by pharmacy managers. Key words: prioritization, pharmacy activities and services, influential factor
DI-068â Beliefs, knowledge and expectations about medicines and pharmacists in asthma and pulmonary arterial hypertension patients: preliminary results: https://ejhp.bmj.com/content/22/Suppl_1/A101.1
International audienceBackground Chronic diseases have changed the management of patients and their status, to move toward a new âpatient-healthcare providersâ partnership. Asthma and pulmonary arterial hypertension (PAH) are two chronic thoracic diseases with differences in terms of prevalence and drug delivery process. Little is known regarding patientâs beliefs (B), knowledge (K) and expectations (E) of their illness, medicines and healthcare providers, despite these parameters influencing their adherence, behaviour and outcomes.Purpose To gain detailed insight into B, K and E of medicines and pharmacists from asthma or PAH patients.Material and methods For this observational prospective monocentric study, an interview guide was designed and validated to perform the semi-structured interviews (SSI). Each interview was recorded and fully transcribed. An inductive approach was conducted for the remaining text to inventory verbatim. All were classified according to the key ideas to describe B, K, E for each population.Results SSI were conducted with 14 patients (5 asthmaâ9 PAH) (mean duration 37 ± 10 min) from December 2013 to April 2014. Medicines were perceived as a ânecessityâ (6 PAHâ3 asthma), a âconstraintâ (3 PAH) or âpoisonsâ (2 asthma). Three asthma patients didnât perceive the necessity of corticosteroids but all judged salbutamol and terbutaline as vital. Four PAH patients noticed few people and healthcare professionals who knew PAH and its management. Pharmacists could sometimes be perceived only as âretailersâ (2 PAHâ3 asthma), âadvisorsâ (3 PAH) or associated with âmedicinesâ (2 PAHâ2 asthma). Tasks of pharmacists werenât well known and defined (5 PAHâ4 asthma).Conclusion Medicines and pharmacists were perceived differently depending on asthma or PAH patients. The ignorance about âwhat exactly pharmacists doâ makes their role ambiguous for the patients leading to difficulties in describing their expectations of pharmaceutical care. More interviews are warranted to improve the B, K, E description of our populations
SpĂ©cificitĂ©s des stratĂ©gies d'adaptation en cas de syndrome de fatigue chronique identifiĂ©es dans une enquĂȘte flash française pendant le confinement de COVID-19
International audienceThe COVIDâ19 pandemic has focused health systems on supporting patients affected by this virus. Meanwhile in the community, many other contained patients could only use selfâcare strategies, especially in countries that have set up a long and strict containment such as France. The study aimed to compare coping strategies deployed by patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS; a poorly recognised syndrome) to those with better known and referenced chronic conditions. An online flash survey was conducted during the containment period in partnership with French Patients Organizations including ME/CFS national association. Therefore, âBrief COPEâ version of Lazarus and Folkman's Ways of Coping Check List has been adapted to the specificity of the containment. The survey was eâdistributed in France from 15 April to 11 May 2020. Differences of coping strategies were analyzed using WilcoxonâMannâWithney test. Amongst 637 responses, 192 were complete, presenting a wide variety of diseases, including 93 ME/CFS. The latter have significantly different coping strategies than recognised diagnosed diseases patients: similar uses of emotion focused coping but less uses of seek social support and problemâfocused copings. In conclusion, coping strategies are different for those who deal with the daily experience of ME/CFS, highly disabling chronic condition with diagnostic ambiguity, low degree of medical and social recognition and without treatment. Better understanding of those strategies is needed to provide the means for health promotion researchers, managers and clinicians, to accompany those patients.La pandĂ©mie de COVID-19 a concentrĂ© les systĂšmes de santĂ© sur le soutien aux patients touchĂ©s par ce virus. Pendant ce temps, dans la communautĂ©, de nombreux autres patients confinĂ©s ne pouvaient utiliser que des stratĂ©gies d'auto-soins, en particulier dans les pays qui ont mis en place un long et strict confinement comme la France. L'Ă©tude visait Ă comparer les stratĂ©gies d'adaptation dĂ©ployĂ©es par les patients atteints d'encĂ©phalomyĂ©lite myalgique/syndrome de fatigue chronique (EM/SFC ; un syndrome mal reconnu) Ă celles de patients souffrant de maladies chroniques mieux connues et rĂ©fĂ©rencĂ©es. Une enquĂȘte flash en ligne a Ă©tĂ© menĂ©e pendant la pĂ©riode de confinement en partenariat avec des associations de patients françaises dont l'association nationale ME/CFS. Par consĂ©quent, la version "Brief COPE" de la liste de contrĂŽle des moyens de faire face de Lazarus et Folkman a Ă©tĂ© adaptĂ©e Ă la spĂ©cificitĂ© du confinement. L'enquĂȘte a Ă©tĂ© distribuĂ©e par voie Ă©lectronique en France du 15 avril au 11 mai 2020. Les diffĂ©rences de stratĂ©gies d'adaptation ont Ă©tĂ© analysĂ©es Ă l'aide du test de Wilcoxon-Mann-Withney. Parmi les 637 rĂ©ponses, 192 Ă©taient complĂštes, prĂ©sentant une grande variĂ©tĂ© de maladies, dont 93 EM/SFC. Ces derniers ont des stratĂ©gies d'adaptation significativement diffĂ©rentes de celles des patients atteints de maladies diagnostiquĂ©es : utilisation similaire de l'adaptation centrĂ©e sur les Ă©motions, mais utilisation moindre de la recherche de soutien social et de l'adaptation centrĂ©e sur les problĂšmes. En conclusion, les stratĂ©gies d'adaptation sont diffĂ©rentes pour ceux qui font face Ă l'expĂ©rience quotidienne de l'EM/SFC, une maladie chronique hautement invalidante, au diagnostic ambigu, au faible degrĂ© de reconnaissance mĂ©dicale et sociale et sans traitement. Une meilleure comprĂ©hension de ces stratĂ©gies est nĂ©cessaire pour donner les moyens aux chercheurs, gestionnaires et cliniciens de la promotion de la santĂ©, d'accompagner ces patients