Effect of a French Experiment of Team Work between General Practitioners and Nurses on Efficacy and Cost of Type 2 Diabetes Patients Care

This study aims to assess the efficacy and the cost of a French team work experiment between nurses and GPs for the managing of type 2 diabetes patients. Our study was based on a case control study design in which we compare the evolution of process (standard follow-up procedures) and final outcomes (glycemic control), and the evolution of cost. The study is realized for two consecutive periods between type 2 diabetes patients followed within the team work experiment (intervention group) or by "standard" GPs (controlled group). After 11 months of follow-up, we showed that patients in the intervention group, compared with those in the controlled group, have more chances to remain or to become: correctly followed-up (with OR comprise between 2.1 to 6.8, pPrimary health care, Diabetes mellitus, Health care team, Comparative study, Outcome and process assessment, Cost analysis

Barometre des pratiques en medecine liberale Resultats de l'enquete 2006 "L'organisation du travail et la pratique de groupe des medecins generalistes bretons

Face aux nouveaux enjeux épidémiologiques (maladies chroniques), à l’exigence croissante en termes de qualité et d’efficience des soins ou encore les tensions de la démographie médicale, de nombreux auteurs plébiscitent un renforcement de la médecine de première ligne et des soins primaires. Le regroupement de médecins en cabinet de groupe s’inscrit dans cette logique. Il permettrait en effet, par la mutualisation des moyens, d’améliorer la production de soins et services. Toutefois, on ne dispose que de peu de données concernant la pratique de groupe en France. Davantage d’informations sont nécessaires pour envisager l’éventuelle mise en place de politiques incitatives. L’objectif de cette étude est donc de décrire la pratique de groupe, de la comparer avec la pratique individuelle et d’identifier les éventuels leviers utilisables par les décideurs publics à travers l’identification des motivations des médecins évoluant en groupe ou non.job organization, health, older workers

Reducing Marginalization of Fishermen through Participatory Action Research in the Zambezi Valley, Zimbabwe

Equitable sharing of fishing resources has been the major source of tension between Zambezi Valley communities and the Zimbabwe government authorities since the 1950s following the Kariba Dam-induced resettlement. Using participatory action research, it was found that the fishing license system and criminalization of fishermen were the major sources of tension between fishermen and government authorities. Engaging with government authorities to address these tensions, fishermen were recognized as partners in the fishing industry. The conclusion was that enhancing community agencies through participatory action research would be fundamental towards creating socially just and equitable arrangements that could emancipate marginalized communities from abject poverty

Performance Scores in General Practice: A Comparison between the Clinical versus Medication-Based Approach to Identify Target Populations

CONTEXT: From one country to another, the pay-for-performance mechanisms differ on one significant point: the identification of target populations, that is, populations which serve as a basis for calculating the indicators. The aim of this study was to compare clinical versus medication-based identification of populations of patients with diabetes and hypertension over the age of 50 (for men) or 60 (for women), and any consequences this may have on the calculation of P4P indicators. METHODS: A comparative, retrospective, observational study was carried out with clinical and prescription data from a panel of general practitioners (GPs), the Observatory of General Medicine (OMG) for the year 2007. Two indicators regarding the prescription for statins and aspirin in these populations were calculated. RESULTS: We analyzed data from 21.690 patients collected by 61 GPs via electronic medical files. Following the clinical-based approach, 2.278 patients were diabetic, 8,271 had hypertension and 1.539 had both against respectively 1.730, 8.511 and 1.304 following the medication-based approach (% agreement = 96%, kappa = 0.69). The main reasons for these differences were: forgetting to code the morbidities in the clinical approach, not taking into account the population of patients who were given life style and diet rules only or taking into account patients for whom morbidities other than hypertension could justify the use of antihypertensive drugs in the medication-based approach. The mean (confidence interval) per doctor was 33.7% (31.5-35.9) for statin indicator and 38.4% (35.4-41.4) for aspirin indicator when the target populations were identified on the basis of clinical criteria whereas they were 37.9% (36.3-39.4) and 43.8% (41.4-46.3) on the basis of treatment criteria. CONCLUSION: The two approaches yield very "similar" scores but these scores cover different realities and offer food for thought on the possible usage of these indicators in the framework of P4P programmes

The european primary care monitor: structure, process and outcome indicators

<p>Abstract</p> <p>Background</p> <p>Scientific research has provided evidence on benefits of well developed primary care systems. The relevance of some of this research for the European situation is limited.</p> <p>There is currently a lack of up to date comprehensive and comparable information on variation in development of primary care, and a lack of knowledge of structures and strategies conducive to strengthening primary care in Europe. The EC funded project Primary Health Care Activity Monitor for Europe (PHAMEU) aims to fill this gap by developing a Primary Care Monitoring System (PC Monitor) for application in 31 European countries. This article describes the development of the indicators of the PC Monitor, which will make it possible to create an alternative model for holistic analyses of primary care.</p> <p>Methods</p> <p>A systematic review of the primary care literature published between 2003 and July 2008 was carried out. This resulted in an overview of: (1) the dimensions of primary care and their relevance to outcomes at (primary) health system level; (2) essential features per dimension; (3) applied indicators to measure the features of primary care dimensions. The indicators were evaluated by the project team against criteria of relevance, precision, flexibility, and discriminating power. The resulting indicator set was evaluated on its suitability for Europe-wide comparison of primary care systems by a panel of primary care experts from various European countries (representing a variety of primary care systems).</p> <p>Results</p> <p>The developed PC Monitor approaches primary care in Europe as a multidimensional concept. It describes the key dimensions of primary care systems at three levels: structure, process, and outcome level. On structure level, it includes indicators for governance, economic conditions, and workforce development. On process level, indicators describe access, comprehensiveness, continuity, and coordination of primary care services. On outcome level, indicators reflect the quality, and efficiency of primary care.</p> <p>Conclusions</p> <p>A standardized instrument for describing and comparing primary care systems has been developed based on scientific evidence and consensus among an international panel of experts, which will be tested to all configurations of primary care in Europe, intended for producing comparable information. Widespread use of the instrument has the potential to improve the understanding of primary care delivery in different national contexts and thus to create opportunities for better decision making.</p

L’organisation des soins de premiers recours en France : une réforme en quête de projet ?

After outlining the main characteristics of the organization of ambulatory care, we will examine the reforming impact of two changes underway in the ambulatory care sector in France: the 2004 attending physicians’ reform and the reform of the university curriculum for general practice, both the result of a long process and numerous compromises. In light of the processes of their emergence, these reforms essentially appear to be a reaction to conjunctural factors and their reforming impact seems modest compared with the underlying challenges. Nevertheless, we will examine the effects of the systemic changes resulting from these incremental changes. To conclude, in comparing the current dynamic of reform and the broader structural changes that we believe to be necessary, we will develop an argument for the need to bring the elements of reform together coherently within the framework of a global project that can make sense to the various actors involved (healthcare professionals, political actors, patient associations, etc.)Après un exposé des principales caractéristiques de l’organisation des soins ambulatoires, nous nous interrogerons sur la portée réformatrice de deux changements à l’oeuvre dans le secteur des soins ambulatoires en France: la réforme du médecin traitant de 2004 et celle du cursus universitaire de la médecine générale, résultants tous deux d’un long processus et de compromis multiples. Ils apparaissent, par leur processus d’émergence, de nature essentiellement réactive aux éléments conjoncturels et d’une portée réformatrice modestes en regard des enjeux sous jacents. On peut néanmoins s’interroger sur les effets de changements systémiques à termes de ces évolutions incrémentales. En conclusion, au regard de la dynamique actuelle de la réforme et des transformations structurelles de plus grande ampleur que nous croyons nécessaires, nous développerons la thèse d’une nécessaire mise en cohérence des éléments de réformes dans le cadre d’un projet global pouvant faire sens aux différents acteurs impliqués (professionnels de santé, acteurs politiques, associations de malades, etc.).Bourgueil Yan. L’organisation des soins de premiers recours en France : une réforme en quête de projet ?. In: Santé, Société et Solidarité, n°2, 2008. Bilan des réformes des systèmes de santé. pp. 105-114

Réduction des inégalités sociales de santé et interventions [dans] les soins primaires (une revue de la littérature)

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

Régionalisation du système de santé (une réforme sanitaire pour quelle gouvernance ?)

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Collaboration of primary care and public health at the local level: observational descriptive study of French local health contracts

International audienceAim: In this paper, we report on a study investigating the involvement of primary care providers in French local health contracts. Background: Worldwide actions are carried out to improve collaboration between primary care and public health to strengthen primary healthcare and consequently community health. In France, the local health contract is an instrument mobilising local stakeholders from different sectors to join in their actions to improve the health of the population. Methods: We developed an instrument to analyse the frequency and nature of involvement of primary care providers in 428 action plans extracted from a sample of 17 contracts (one per French region). The number of primary care actions were counted, and thematic analyses were conducted to identify the nature and level of involvement of the professionals. Findings: Primary care providers were involved in 20.1% (n = 86) of the action plans and were mostly described as a target of the action rather than leaders or partners. Within those action plans, 76.7% (n = 66) of these action plans aimed to improve access to care for local communities; an issue that appears as the main driver of collaboration between public health and primary care actors

Advancing Primary Care in France and the United States

Primary care has been identified as key to improving health care delivery systems across the globe. France and the United States have been ranked low on scales of primary care orientation. However, each nation has developed significant approaches to structuring primary care and organizing primary care-focused systems. This article reviews those efforts and finds that both nations face similar barriers to implementing many primary care initiatives