Tesi sul tema "Soins de santé primaires – Réforme"
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Morize, Noémie. "Les coûts de l’autonomie : économistes et médecins libéraux dans les réformes expérimentales des soins primaires". Electronic Thesis or Diss., Paris, Institut d'études politiques, 2024. http://www.theses.fr/2024IEPP0009.
Testo completoIn the primary care sector in France, “Multidisciplinary Primary Care Groups,” or MSPs, have progressively been introduced to enhance care coordination between self-employed healthcare professionals. These initiatives diversify the predominantly fee-for-service-based remuneration model within primary care, by adding publicly funded add-on payments for coordination efforts. Two pilot programs launched in 2019 sought to advance these reforms further, striving to increase care professionals’ accountability by providing financial incentives for reaching common health outcome goals for their shared patient groups. These initiatives were conceived by administrative executives trained in economics and received support from self-employed general practitioners. This doctoral study aims to explore the mechanisms behind the unlikely collaboration between general practitioners, traditionally known for their autonomy, and stakeholders seeking to reform the self-employed system in primary care.Through case studies involving qualitative data collection from 2019 to 2023, including observations and approximately one hundred interviews, the study reveals a group of stakeholders including administrative economists, researchers, and self-employed health professionals, advocating for these pilot programs and open to compromises to achieve their respective goals. Administrative economists adapt their strategies to maintain their relationships with practitioners, while some general practitioners, well versed in economic principles, seek to reorganize care accordingly. However, they also assert their central position in professional relationships
Tang, Lingyue. "Being both a doctor and a state employee : grassroots medical professionals in contemporary China". Electronic Thesis or Diss., Paris, Institut d'études politiques, 2023. http://www.theses.fr/2023IEPP0049.
Testo completoThe development of grassroots healthcare systems is a key element of China’s current healthcare reform. This study focuses on a group that has often been overlooked in previous research - grassroots medical professionals. They hold a unique dual identity, being both professionals and state employees, setting them apart from conventional professional paradigms and urban doctors. Through in-depth fieldwork in central China, including interviews, participant observations, and a comprehensive analysis of online media, this research reveals that different institutional designs and social contexts result in different practice conditions for medical professionals in three-tiered primary medical institutions, as well as varying degrees of attachment to medical institutions and local governments. As the ultimate bearers of a hierarchical chain of control, they are subject to constant state intervention, including supervision, inspection, and technological management, which severely erode their professional autonomy. Beyond their daily medical and administrative duties, grassroots medical professionals also undertake a substantial number of political tasks, and the tension between their dual identity varies in different types of tasks. The transformation of medical professionals’ dual identity is dynamic, driven not only by the needs of the state, but also influenced by the complex interactions of multiple interest groups, and even, in some cases, medical personnel have become a figurative extension of state power to penetrate rural society. Moreover, this study, through a meticulous analysis of healthcare policies from local experiments to central directives and their subsequent local execution, also illuminates the logic of political functioning and the mechanisms for responding to health crises in China
Petitfour, Laurène. "Potential for improvement of efficiency in health systems : three empirical studies". Thesis, Université Clermont Auvergne (2017-2020), 2017. http://www.theses.fr/2017CLFAD012/document.
Testo completoIn the perspective of the third Sustainable Development Goal ("Good Health and Well-being"), it is necessary to increase financial resources for health in low income countries, but also to ensure that those resources are optimally allocated. To this purpose, efficiency measures appear as a useful tool to assess the performance of healh systems at the macroeconomic level, or of health facilities as the microeconomic level to get "more health for the money" (WHO,2010). Through its four chapters, this thesis provides some empirical evidence to the assessment of the efficiency of health system.The first chapter is a methodological review of nonparametric efficiency measures, used in the three empirical studies that follow. The second chapter assesses the efficiency of a sample of 120 low and middle income countries over the 1997/2014 period. Production function is defined as health expenditures producing health outcomes (maternal and juvenile survival). It concludes that, for the same health outcomes, countries could spend more than 20\% for the same health outcomes, and that inefficiency increases with the level of development of coutries. The last two chapters are case studies. The third one focuses on Township Health Centers in Weifang, Shandong province, China, relying on survey data. It highlights the potential for performance improvement and the role of demand side determinants and of the share of subsidies in incomes to explain efficiency scores. The fourth chapter deals with the efficiency of primary healthcare facilities in Ulan-Bator, Mongolia. It concludes that efficiency could be spurred by about 30\%. Demand side factors are positively associated to efficiency, but low levels of staff remuneration, as well as a suboptimal balance between medical and non-medical staff seem to hinder activity and efficiency of health facilities
Duconge, Jean-Patrick. "Les soins de santé primaires en Guinée". Montpellier 1, 1992. http://www.theses.fr/1992MON11137.
Testo completoGbabode, Placide. "Le système sanitaire et les soins de santé primaires en République centrafricaine". Bordeaux 2, 1993. http://www.theses.fr/1993BOR2M036.
Testo completoAmmar, Walid. "Système de santé et réforme au Liban". Bordeaux 2, 2001. http://www.theses.fr/2001BOR28837.
Testo completoThe objective of this thesis is to study the situation of nurses in Lebanon based on a long experience in this field in this country. We decide to seek the causes of this occultation and list the encountered problem. We have started in 1996 study that has shown that nurses in Lebanon belong to a young, single female population with a very short professional carrier averaging 5 years. Nurses live badly due work conditions described, as stressful and hard. The load is both physical and mental. The burn out syndrome affects the majority, of this group. Adding to their lifestyle, the lack of esteem to their not well defined profession. This social group was unable to find structures that will help him to be organized. The study helps us to identify the problems that impeach this group from having its well-defined identity. We were able to formulate four major causes : - The immaturity of the young nurses. - The lack of the elaboration of their specific science. - The lack of structure. Suggestions, that can help this social group to find it self and acquire a real identity, the structures that well help this group to be organized. The reorientation of teaching programs towards specific knowledge, consequently, towards an essential role able to health needs of the human being
St-Onge, Mélanie. "Continuité relationnelle dans les soins de santé mentale primaires : réflexion, conceptualisation et mesure". Thèse, Université du Québec à Trois-Rivières, 2012. http://depot-e.uqtr.ca/6191/1/030404024.pdf.
Testo completoWey, John. "Les soins de santé primaires et la mobilisation paysanne au Nigéria : exemple du shomolu". Nice, 1996. http://www.theses.fr/1996NICE2042.
Testo completoAbstract: this work claims to be a socio-ethnological contribution to public health studies in nigeria. Confronted with the tremendous problem of health in the third world countries, the world health organization set up a program of primary health care (phc) which was intended to be a "universal remedy". In the first part, we will go over the principles on which the phc program rested. Although legitimate, this strategy still overshadows real problems which can cause its failure. Then, we will review in details the status and the role of the social actors of this policy through their mutual representations. We will next proceed with a comparative study of the urban and rural health systems. We will report that in both cases, the federal state is being stigmatized. The state's failure is most evident in the socio-economic field: unable to grant the financial means to go with this program, it aroused a total disengagement by the rural population and by the village health agents (vha)
Jego, Maéva. "Améliorer la santé des personnes sans chez-soi : vers quelles innovations organisationnelles en soins primaires ?" Thesis, Aix-Marseille, 2019. http://www.theses.fr/2019AIXM0211/document.
Testo completoAim: to identify new forms of organization and adaptations to develop in primary care to improve the care of Homeless People (HP).Method: research by mixed methods. In the first phase we explored the views of general practitioners (GPs) about how they can provide care to HP. In the second phase we led a literature review, to describe the main characteristics of the primary care programs that take care of homeless people, and to identify which could be most relevant. In the third phase, we explored the experience and views of HP about primary care.Results: GPs expressed the need to develop medical and psychosocial approach with closer relation with social workers. In the litterature, almost all homelessness programs developed a multidisciplinary approach and / or offered co-located mental health, physical health and social services. Some characteristics were associated with significant positive outcomes: tailored primary care organizations, clinic orientation, multidisciplinary team-based models which included primary care physicians and clinic nurses, integration of social support, and engagement in the community’s health. The interviews with HP showed central relational expectations of HP for their general practitioner. More than a medical response, they expected to be listened to, considered and understood.Conclusion: Primary care programs that wish to better care for HP should develop a multidisciplinary, medico-psycho-social approach. The patient-centered approach appears warranted to improve the care experience of these patients
Potvin, Pronovost Diane. "Intégration de la philosophie des Soins de Santé Primaires au programme de formation initiale de niveau collégial en soins infirmiers". Mémoire, Université de Sherbrooke, 1995. http://hdl.handle.net/11143/11205.
Testo completoChaneliere, Marc. "La sécurité du patient en soins primaires : éléments conceptuels, épidémiologie, interventions auprès des professionnels de santé". Thesis, Lyon, 2017. http://www.theses.fr/2017LYSE1015/document.
Testo completoPrimary care is for patients the first level of contact with the healthcare system, providing answers in 90% of the health-related issues. Patient safety incidents (PSI) are common, reducing quality and safety of care. This work deals with patient safety in primary care. In a first part, this work considers the terminology and epidemiology related to PSI in primary care (through ECOGEN and ESPRIT studies). In a second part, the concept of patient safety culture is discussed, as well as its assessment with professionals or medical students. An international literature review and the translation of a survey for medical students are exposed. In a third part, three examples of risk management elements deployed in primary care are introduced: morbidity and mortality reviews, a PSI reporting system for general practitioners, and a tool for root cause analysis dedicated to primary care (CADYA)
Gagnon, Noëlla. "Élaboration et mise à l'essai d'un modèle de formation des attitudes en soins de santé primaires". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape8/PQDD_0016/MQ56906.pdf.
Testo completoThompson-Leduc, Philippe. "Prévalence et facteurs de risque associés au conflit décisionnel cliniquement significatif en soins primaires". Master's thesis, Université Laval, 2015. http://hdl.handle.net/20.500.11794/27540.
Testo completoClinically significant decisional conflict (CSDC) leads to poor patient outcomes. We sought to identify the prevalence of CSDC in primary care using the Decisional Conflict Scale (score ≥ 25/100) in five datasets of patients who consulted in primary care. We identified its risk factors using logistic regression analysis. Selection of variables was based on a review of the literature and on their availability in the datasets. The prevalence of CSDC in primary care varied between 10% and 31% depending on the dataset, a variation that could reflect the different types of decisions addressed. Overall, CSDC was more prevalent in males, people aged 45 and over and people living alone. Healthcare professionals should be trained in screening for CSDC in order to reduce poor patient outcomes.
Soubeiga, André. "Les stratégies des soins de santé primaires au Burkina Faso : mobilisation communautaire et logiques paysannes : l'exemple de la Sissili". Bordeaux 2, 1993. http://www.theses.fr/1993BOR21004.
Testo completoIn common with most countries of the third world, members of the world health organization (W. H. O. ), Burkina Faso has adopted, within the framework of its health policy the primary health care strategy, decided at Alma Ata in 1978. The present study attempts through a village based study, to take account of the principal factors (economic, social, cultural and political) which determine the process governing adhesion or no-adhesion to this governmental program, within a village community (situated in Sissili, a southern province). Thus, the state strategy, which is based on the philosophy of the villager's self-governing their health, corresponds only rarely with their own conception of health care and the role of the state. This conception constitutes the principal ground of resistance among the villagers, who exercise multiple strategies with the intention of escaping from the state's constraints. These phenomena are revealed through peasant's behavior and encountered in socio-cultural and socio-political studies of rural mobilization, as well as in the relationship between community health workers (key figures) and the primary health care strategy
Ait, Ouchannik Sadia. "Les mutations contemporaines de l'organisation des soins en santé mentale : répercussions sur les pratiques de soins psychiques et sur la subjectivité". Electronic Thesis or Diss., Amiens, 2019. http://www.theses.fr/2019AMIE0007.
Testo completoMultiple reforms aiming at modernizing the public utilities and controling in a better way their spending have gradually transformed the running and organization of public health institutions in our country. A complete overhaul according to the terms of the new hospital governance accompanied with the introduction of management tools stemmed from New Public Management has been carried out. This work is about the transformations of care organization in health care facilities. The study of the proceduralization of care practices allowed to bring to the fore the role of Evidence-Based Medicine in the enterprise of standardization in care systems. Effects of these management logics on the different registers of the intersubjective bond have been grasped, bringing out the forms they spread in group dynamics and teams instituted, with in the background the transformations of sociocultural meta-framework. A particular care has been attached to health managers'view considering the specificity of their task which set them at the crossroads of clinical, managerial and administrative dimensions. The analysis of clinical situations allowed to bring out the sight of the medicalization of psychological suffering and the extension of the concept of "psychic handicap". Transformations in the notion of psychic care have been confronted with mental health paradigm ; Michel Foucault's work has enable to show that mental health policy system are part of a mode of neoliberal governmental rationality framework
Bussière, Clémence. "Recours aux soins de santé primaires des personnes en situation de handicap : analyses économiques à partir des données de l’enquête Handicap-Santé". Thesis, Université Paris-Saclay (ComUE), 2016. http://www.theses.fr/2016SACLS049/document.
Testo completoDisability is multifactorial. All its components are potential sources of barriers and disadvantages. The originality of this thesis is to take into account the complexity of disability definition to analyze the use of primary health care. The ultimate goal of primary health care is better health for all, reducing exclusion and social inequalities in access to the health care system. We approach disability in different ways, ending with a model that includes the three dimensions of a “disability situation” (functional dimension, environmental dimension and social participation). First we analyze the functional dimension considering people with disabilities as physically limited. Then, we investigate the environmental dimension through analysis among adults living in institutions. Finally, we adopt a global vision of disability that integrates all the dimensions simultaneously through the measures of latent capabilities. The estimated model approximates a fundamental inter-individual comparability and reveals all things being equal, the levels on which to act to overcome inequalities. The analyses suggest that favorable environment, societal and/or socioeconomic could offset the negative impact of the limitations and cognitive and physical restrictions. We conclude on several possible waysto improve the use of primary care: acting on the environmental dimension and acting on social participation
Jacquet, Frédéric. "Les stratégies participatives pour une promotion de la santé". Montpellier 1, 1996. http://www.theses.fr/1996MON11009.
Testo completoBrunat, Marion. "Analyse économique de l'accessibilité des soins primaires en France : la question de l'organisation de l'offre de services de santé ambulatoires". Grenoble, 2010. http://www.theses.fr/2010GRENE008.
Testo completoThe objective of this work is to bring to bear a critical reflection on the choices of public policy in the fight against health inequalities, through the utilisation of the concept of " real possibilities for access " as applied to both preventive and curative care. In a neo-institutional economic approach, we develop an analysis of the accessibility of medical care recognising the importance of the financial aspect and integrating the structural characteristics of cane supply and professional practice. We stress the limits of the CMU-C provision in an unchanged institutional and organisational system. An econometric study of logistical regression on the bases of medical consumption in 2007 by beneficiaries of CMU-C supports the position we take. Thus we stress the need for a reflection on the benefits and ways of developing an integrated and pluri-professional supply of health services (health centres and " maisons de santé "). We make use of documentation provided by semi-directive interviews with several persons of the whole health sector. These differing forms of organisation are a fruitful avenue to explore to improve coordination, continuity and global healthcare service. Nevertheless, their development depends on internal choices of organisations to achieve an economic gain in terms of the cooperation of professionals. It depends also on the rules and perceptions pertaining to the system at the institutional level. Their emergence as structured ways of supplying primary health care as a means of reducing health inequalities depends on the development of new organisational forms of outpatient healthcare supply as well as their adequate institutional recognition
Dousteyssier, Laurent. "Réflexions sur le droit à la santé : à propos de l'expérience du Centre de soins gratuits de "Médecins du Monde" de Bordeaux". Bordeaux 2, 1993. http://www.theses.fr/1993BOR2M184.
Testo completoKaluma, Katembo. "L'influence des dimensions des soins de santé primaires (SSP) sur les résultats des programmes de santé (cas de la participation habilitante ou empowerment)". Thesis, Université Laval, 2009. http://www.theses.ulaval.ca/2009/26646/26646.pdf.
Testo completoFerron, Parayre Audrey. "Le dépistage du conflit décisionnel chez les patients en soins primaires : Validation du test SURE". Thesis, Université Laval, 2013. http://www.theses.ulaval.ca/2013/29542/29542.pdf.
Testo completoThis study validated the psychometric properties of a screening tool assessing decisional conflict, the SURE test, in patients with acute respiratory infection who had to make a decision about taking antibiotics or not. Using a self-administered questionnaire which was provided immediately after the medical encounter, 712 patients recruited in nine family practice teaching units related to Laval University were asked to respond to SURE and Decisional Conflict Scale (DCS) questions, the gold-standard measure of decisional conflict. The internal consistency using Kuder-Richardson 20 coefficient was 0.7, and there was a significant correlation between DCS and SURE scores (P<0.0001). Sensitivity and specificity were 94.3% (79.4-99.0) and 85.2% (82.2-87.8, respectively. This study suggests that the SURE test is appropriate to screen for decisional conflict in primary care. The validity of the test in different decisional contexts should be evaluated.
Becerra, Perez Maria Margarita. "Fréquence de regret décisionnel après une consultation en médecine de première ligne et ses facteurs associés". Master's thesis, Université Laval, 2016. http://hdl.handle.net/20.500.11794/27550.
Testo completoAfin d’estimer la fréquence du regret décisionnel de patients suite à une consultation médicale et d’en identifier les facteurs de risque, nous avons réalisé une analyse secondaire d’une banque de données portant sur 258 consultations en soins de première ligne. À l’aide de l’Échelle de Regret Décisionnel (ÉRD), nous avons observé que la moyenne ± écart-type et la médiane du score de regret décisionnel étaient respectivement de 11.7 ± 15.1 et de 5 (sur une échelle de 0 à 100). Au total 43% des participants n’éprouvaient aucun regret (score = 0), alors que 45% avaient un score compatible avec un faible regret (score = 5 – 25) et 12% avaient un regret plus élevé (score ≥ 30). Après ajustement pour l’âge et le niveau d’éducation des patients ainsi que pour le sexe et le statut des cliniciens, seul un niveau élevé de conflit décisionnel fut identifié comme facteur de risque du regret. La fréquence de regret décisionnel en première ligne justifie des approches ciblant la réduction du conflit décisionnel.
To estimate the frequency of decision regret and examine risk factors associated with regret, we conducted a secondary analysis of data collected from 258 primary care consultations. With the Decision Regret Scale, we observed that mean ± standard deviation and median decision regret scores were 11.7 ± 15.1 and 5 respectively (on a scale of 0 to 100). Overall, 43% of participants did not experience decision regret (score = 0), while 45% experienced mild regret (score = 5 – 25) and 12% experienced higher regret (score ≥ 30). After adjusting for patient age and education level as well as physician gender and status, a high level of decisional conflict was identified as the only risk factor of regret. The frequency of decision regret in primary care justifies approaches targeting the reduction of decisional conflict.
Sanon, Priscille-Nice. "Travail de proximité dans des groupes de médecine de famille : la présence du pharmacien et la collaboration interprofessionnelle". Master's thesis, Université Laval, 2017. http://hdl.handle.net/20.500.11794/27925.
Testo completoPharmacists’ work in family medicine group (FMG) and their role in the management of clients with complex needs is an innovation in Quebec province whose have hardly been studied. The objectives were to assess the integration of pharmacists and to study the influence of their presence in these multidisciplinary care teams on interprofessional collaboration. A qualitative study was conducted using semi-structured interviews and questionnaires (Pharmacist-Physician Collaborative Index (PPCI) and Team Climate Inventory (ICE)) with doctors (Md), pharmacists and other professionals inside and outside four FMGs in Quebec city. A thematic content analysis was performed for the interviews. Statistical analyzes describing collaboration, team climate and comparing different backgrounds and professionals were also carried out. We met 45 professionals (6 pharmacists (inside FMG), 13 MD, 11 others, 15 pharmacists (outside FMG). Pharmacists were working in FMG since a mean of 3.75 years. Interviews indicate that the successful integration of the pharmacist into FMG requires time and effort from the organization, pharmacists and other professionals, particularly with respect to understanding roles. The level of collaboration between doctors and pharmacists is high with lower scores on two dimensions (i.e. definition of roles and working relationships). Team climate is generally good with higher scores for FMGs having a focus on training (university affiliated). These results allow a better understanding of the integration of the pharmacist into family medicine groups and on the organizational impacts that these health professionals can have in primary care teams.
Leleu, Henri. "Mesure de la continuité longitudinale dans le champ des soins primaires dans le contexte français". Phd thesis, Université Paris Sud - Paris XI, 2014. http://tel.archives-ouvertes.fr/tel-00964126.
Testo completoRioux-Dubois, Annie. "L'intégration et la négociation du rôle de l'infirmière praticienne en soins de santé primaires en contexte de collaboration interprofessionnelle". Thesis, Université d'Ottawa / University of Ottawa, 2019. http://hdl.handle.net/10393/38717.
Testo completoDucos, Jean. "L’économie de la médecine libérale". Paris 9, 2010. https://bu.dauphine.psl.eu/fileviewer/index.php?doc=2010PA090023.
Testo completoThis thesis aims to undertake an economic analysis of private medical practice while stressing on elements, which in our view, remain unsaid or unrecognised. It is about an institutional analysis, based on the historic and social embedding of the health. After presenting the specificities of health economics and a history, we will deal with the institutions of private medical practice. The essential features of « supply » are introduced by stressing upon the drawbacks of private medical practice concerning the opportunistic behaviour of private practitioners and the deficiencies in regulation, without ignoring the fact that it is a profession that is suffering and needs recognition. As far as « demand » is concerned, we will stress upon the state of sickness in the economic analysis. Finally, after underlining the problems linked with private medical practice, we will outline proposals with a perspective of developing primary health care. The conclusion will treat the utility factory of private medical practice and it’s future, based upon it’s capability to reform itself
Lompo, Amélie. "Le faible recours aux soins de santé au Burkina Faso : le cas des femmes yadse dans la région Nord". Nantes, 2013. http://www.theses.fr/2013NANT3010.
Testo completoTchicaya, Anastase Jean Robert. "Financement et efficacité des soins de santé primaires : évaluation de la politique de recouvrement des coûts dans la région de Niari au Congo". Dijon, 1994. http://www.theses.fr/1994DIJOE020.
Testo completoOver the last fifteen years, the economic and health situation in most countries of Subsaharian Africa has been characterized by numerous disequilibria which dangerously affect the well-being of their populations. To deal with this, several health care policies have been successively tried in order to increase finances for and efficiency of the health care system with the objective of improving the health status of the population. The overall objective of this thesis is to demonstrate, by means of an evaluation of a local experiment of an organizational and financing model founded on a primary health care approach and the principles of the Bamako initiative, that it is possible to attain the objectives both of economic returns and of improved public health in a context of rare resources at the level of the health care systems of developing countries. This research is thus divided into two parts: the first is devoted to the theoretical bases and to the institutional context of health sector financing, and the second focuses on the socio-economic evaluation of the cost recovery experiment in the Niari region of the Congo. Each part comprises three chapters. The experiment illustrates an organizational and financing model for health care on two levels under the form of a district health system and emphasizes community participation in the financing of health care. The results obtained demonstrate that the efficiency of the health care system can be significantly improved at the same time as geographic and financial accessibility to care at a cost compatible with the population's capacity to pay
Fanaki, Chaimaa. "Optimisation d'un nouveau modèle de soins de santé primaires pour prévenir le déclin fonctionnel des personnes âgées de 70 ans et plus au Québec". Master's thesis, Université Laval, 2020. http://hdl.handle.net/20.500.11794/67911.
Testo completoBackground: In Canada and elsewhere, community-based seniors living with frailty, pre-frailty, or experiencing some limitations in their ability to pursue their daily activities often go unnoticed. Systematic assessment of frailty and of its risk factors in primary care would better meet their needs and prevent their decline. Purpose: The objective of this study is to identify the factors influencing the implementation of a new primary health care trajectory to adapt and eventually implement it in different family medicine groups in Quebec. Method: In this qualitative descriptive study, we conducted 47 semi-structured interviews and 8 focus groups with 32 health care professionals, 27 patients over 70 years of age, 8 health care decision makers from three family medicine clinics in the province of Quebec, 16 representatives of community organizations and 9 representatives of specialized geriatric clinics in surrounding areas. We conducted an inductive/inductive thematic analysis based on the Consolidated Framework for Implementation Research. The data were analyzed using Nvivo12. Results: The various study participants provided several facilitators and barriers to the implementation of the trajectory. The complexity of adding the screening tool to electronic medical record, the lack of communication between primary care practices and community services, as well as public policy effects on community support services' capacity to serve their clients were identified as barriers. These findings support adapting the intervention by 1) allowing the integration of screening into the electronic medical record, 2) defining clinical roles for screening, and 3) sustaining partnership between different health system sectors. Conclusions: Eventually, this project will focus on the determinants influencing implementation over the next few years to ensure that older adults’ health care is improved and adapted to their needs according to a preventive approach.
Mousquès, Julien. "Soins primaires et performance : de la variabilité des pratiques des médecins généralistes au rôle de l'organisation des soins". Thesis, Paris 9, 2014. http://www.theses.fr/2014PA090061/document.
Testo completoAccording to economic research, the general practitioner is considered as an agent that offered information and intellectual services in health to principals. Imperfect convergence between their objectives, like the presence of uncertainties and information asymmetries, lead the physician “to fix” the quantities, the effort and the quality of the care and services delivered. Based on three articles, this thesis aims at identifying the role of the characteristics of the general practitioners and of their practice organization, on activity performance. The first articles analyzes the determinants of the antibiotic prescription for acute rhinopharyngitis variability, the second evaluates the impact of team working with nurses on the quality and the efficiency of the care for diabetic patients, and the third evaluates the impact of multi-professional group practices on the activity and the productive efficiency of GPs and on the utilization of ambulatory health care and by their patients. These researches question the relative weakness of the ambulatory health care regulation in France in terms of health care expenditure containment policies in comparison with that bearing on demand
Frappé, Paul. "Epidémiologie en soins primaires de la thrombose veineuse superficielle des membres inférieurs". Thesis, Saint-Etienne, 2015. http://www.theses.fr/2015STET004T/document.
Testo completoThe potential severity of superficial vein thrombosis (SVT) of the lower limbs has recently been shown by studies perfomed in secondary and tertiary care. The epidemiology of SVT remains unknown in primary care. The first objective of this study was to measure the prevalence of SVT in primary care, and the rate of concomitant thromboembolic events at diagnosis. A collaborative research network between general practitioners and vascular physicians from Saint-Etienne has been set up. A cross-sectional study has been conducted within this network during one year. The annual prevalence of SVT was measured to 0.64 per thousand inhabitants. At diagnosis, 24.6% of SVT were associated with symptomatic deep vein thrombosis and 4.7% with symptomatic pulmonary embolism. A second study was looking for a seasonal variation of SVT frequency by analyzing individual data from three studies with different designs; the STENOX study, the POST study and the STEPH study. A significant variation was found only in the POST study, and peak-to-low ratios were below 1.2 in the three studies. Thus, if other more powerful and exhaustive studies could find a seasonal variation, that variation would probably be of low magnitude and without clinical significance
Driot, Damien. "Comment optimiser la prise en charge et limiter l'impact de la défavorisation sociale des patients atteints d'un trouble anxieux ou d'un trouble dépressif en soins premiers ?" Electronic Thesis or Diss., Toulouse 3, 2023. http://www.theses.fr/2023TOU30259.
Testo completoTitle: How to optimise healthcare and limit the impact of social deprivation for patients with anxiety or depressive disorders in primary care? Introduction: In France, mental disorders are widely prevalent, and affect particularly the most socioeconomically deprived patients. Healthcare management of these precarious patients is also less efficient. Difficulties include the healthcare management of these patients and access to specialised healthcare (psychiatrists, psychologists). Objective: The aim of the work carried out is i) to define the optimal management of anxiety or depressive disorders in primary care, ii) to assess the impact of social deprivation on psychotropic drug prescriptions, and iii) to implement tools to optimise management and limit the impact of social deprivation in these patients. Results: Systematic metareviews were conducted to determine the best practices for managing common mental disorders in primary care. They were used in order to define evaluation criteria for epidemiological studies performed to determine compliance with validated scientific data in the outpatient management of precarious patients with mental disorders. A significant influence of precariousness on inappropriate healthcare management in primary care of patients exposed to psychotropic drugs was shown. The little recourse to non-pharmacological therapies for sleep disorders was highlighted in the department of Haute-Garonne. These findings emphasised the need for actions to enhance patients' management by GP. Firstly, the website psychotropes.fr has been created to provide a tool to help GP with the management of patients encountering a mental health problem. It was created on the basis of the meta-reviews from which healthcare management algorithms have been designed. Secondly, a clinical trial has been proposed to the French Health Insurance to evaluate the efficiency of an experimentation of the reimbursement of psychotherapy for mental health disorders. Conclusion: A clinical trial evaluating the impact of the Psychotropes.fr website on the healthcare management of mental health issues by GP is to be carried out. The research protocol evaluating the reimbursement of psychotherapy was ranked second. This programme was extended to the whole country in 2022, but the adherence of the healthcare professionals is problematic. A collaborative research approach to assess the needs of the various professionals involved, as well as those of patients, could contribute to improving the programme's efficiency
Heinen, Christine. "Guatemala-Ixcan : description du système de soins de santé communautaire mis en place par la mission médecins du monde". Montpellier 1, 1989. http://www.theses.fr/1989MON11062.
Testo completoMazaudier, Eric. "Les soins de santé primaires : réflexions sur les difficultés rencontrées dans leur développement à partir d'une expérience en République du Congo". Bordeaux 2, 1990. http://www.theses.fr/1990BOR23008.
Testo completoBordas, Florence. "Étude de facteurs communautaires intervenant dans la réalisation d'un programme de soins de santé primaires : à partir d'une mission de médecins du monde au Guatemala". Bordeaux 2, 1990. http://www.theses.fr/1990BOR25228.
Testo completoDonnat, Marianne. "Espaces pastoral, médical et sanitaire : le recours aux soins en zone sahélienne : le cas des communautés arabes Juhayna et dazagara du Bahr-el-Ghazal, au Tchad". Montpellier 3, 2006. http://www.theses.fr/2006MON30028.
Testo completoIs the health care system which is available today in the Sahel adapted to the needs of nomadic people? The current use of health facilities by pastoral people reveals specific choices and strategies that are analyzed here with the tools of Health Geography. The study shows the assets but also the disconnections between the pastoral space, the health supply space and the health demand space, with the case-studies among arabic and dazagara communities in western Chad. It suggests practical solutions to encourage a health policy that takes more nomadic people needs into account
Nkogho, Mengue Pamphile-Gervais. "L'évaluation de l'utilisation des médicaments et les déterminants de la prescription de médicaments génériques dans les soins de santé primaires au Gabon". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0018/MQ55871.pdf.
Testo completoSaint-Lary, Olivier. "Paiement à la performance et soins primaires : étude des tensions éthiques liées à son introduction". Thesis, Paris 5, 2014. http://www.theses.fr/2014PA05D021/document.
Testo completoPay for performance (P4P) applied to outpatient care has emerged in the 2000s and has experienced strong growth over the past decade. It was introduced in France under optional form through the Improvement of Individual Contracts Practice (CAPI) in 2009 and was generalized in 2012 with the Compensation on Public Health Objectives (ROSP). Its principle is to allocate additional compensation to doctors in exchange for a better quality of their practice, the latter being measured from a set of indicators. The principles of justice and beneficence that could be strengthened in this context seem in tension with the principle of autonomy. P4P can be regarded as an additional tool to standardize medical practices while reinforcing the exclusion of any singularity. We first asked general practitioners on the notion of medical standard. They appeared to live with the concept without expressing the need to clarify it. They felt that a strict standardization of their practice was impossible. The ethical considerations have structured their statements. We then analyzed the nature of the obstacles to the signature of CAPI from a panel of over 1,000 general practitioners. We identified two profiles of doctors: those feeling ethical risks as generally low and agreeing to sign (31.7%) and those perceiving them strong, refusing to sign (68.3%). The lack of patient information concerning the adherence of their doctor to a P4P contract was the main risk perceived by the non-signatories. Then, we investigated the impact of P4P on a variable associated with the quality of care: the consultation length. Our main result was that the CAPI has not had a significant impact on the consultation length. Finally, we interviewed patients directly. Their opinion was very divided, some thought the allocation of a bonus could improve certain practices such as prevention and screening, others being fundamentally hostile to this principle they considered going against the values care
Ouendo, Edgard-Marius D. "Indigence et soins de santé primaires en République du Bénin: approche de solutions au problème d'identification des indigents dans les formations sanitaires publiques". Doctoral thesis, Universite Libre de Bruxelles, 2005. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/211005.
Testo completoMéthode: Après un état des lieux de la situation des indigents dans le système de santé au Bénin, trois études ont été réalisées pour approfondir la question des indigents;
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Doctorat en Sciences de la santé publique
info:eu-repo/semantics/nonPublished
Poirier, Annie. "Étude des besoins décisionnels des aînés atteints de la maladie d'Alzheimer et de leurs proches aidants pour favoriser la prise de décision partagée en soins de première ligne". Master's thesis, Université Laval, 2016. http://hdl.handle.net/20.500.11794/27090.
Testo completoTurcotte, Véronique. "L'intégration de psychologues dans des équipes multidisciplinaires de première ligne : facteurs facilitant et obstacles". Master's thesis, Université Laval, 2006. http://hdl.handle.net/20.500.11794/18733.
Testo completoLes problèmes d'intégration et de coordination des services, particulièrement en première ligne, perdurent depuis plusieurs années. Les professionnels de la santé de la première ligne travaillent souvent en "silos" et les services offerts aux citoyens suivent rarement un processus de continuité. Intégrer des psychologues au sein des équipes cliniques de première ligne pourrait contribuer à améliorer la continuité, particulièrement entre les services médicaux et psychologiques. La présente étude vise la compréhension du rôle des facteurs individuels, professionnels et organisationnels sur la capacité qu'ont les psychologues à s'intégrer dans des équipes multidisciplinaires de première ligne.
L'étude prend appui sur le modèle de collaboration interdisciplinaire de Sicotte et ses collaborateurs (2002). Une méthode qualitative a été privilégiée, soit une étude multi-sites. Une unité de médecine familiale (UMF) en centre hospitalier et une UMF en Centre de santé et de services sociaux (CSSS) constituent les deux principaux sites à l'étude, soit deux situations de première ligne qui pourraient bénéficier de l'implication de psychologues. Des entrevues individuelles ont été réalisées, en face à face, auprès de médecins, d'infirmiers(ères), de travailleurs sociaux, de psychologues, de résidents en médecine et de gestionnaires (n=19). Les principaux constats révèlent l'existence d'un réel besoin d'informer les professionnels de la santé de la première ligne sur ce qu'est le travail en équipe interdisciplinaire et en quoi consiste l'apport du psychologue au sein d'une équipe de première ligne. Les entrevues révèlent également que la distinction entre les rôles du psychologue et du travailleur social est loin d'être claire.
Laporte, Catherine. "Le médecin généraliste et la consommation de cannabis des adolescents en France". Thesis, Clermont-Ferrand 1, 2016. http://www.theses.fr/2016CLF1MM20/document.
Testo completoA major public health issue in many countries, the consumption of cannabis is higher in France thananywhere else in Europe. In 2014, nearly a quarter of French youths aged 15 to 25 were monthlyconsumers. Smoking cannabis has somatic, psychiatric and social consequences, and there is a high riskof a fatal accident during or after consumption. Consumption is responsible for cerebral micro-lesions inadolescents in particular, the effects of which are often irreversible. In France, 80% of young peopleaged 15-25 consult a general practitioner (GP) in a typical year, making these professionals ideallyplaced to detect and advise on cannabis use early on. Few general practitioners question their patientsabout their intake, however. Brief Intervention (BI) is a motivational, patient-centered interviewtechnique designed to change behavior, and studies have shown its acceptability and feasibility forusers, including younger consumers’. GPs could make use of it to identify and treat cannabis users.Two qualitative studies were carried out, one using individual interviews with young users, the otherby focus group with the GP, in order to better understand the relationship and to improvecommunication between them. The qualitative study among adolescents highlighted the ambivalencepeculiar to this age group and to substance use in particular. They perceived the GP to be a judge and apossible informer, but also a benevolent authority and a privileged interlocutor in discussions aboutdrug use. A lack of time, and poor knowledge of the GP were perceived to be obstacles to dialogue, butknowing the MG for a long time made matters easier. Studying GPs also revealed an ambivalence:conscious of the dangers of cannabis, they nevertheless conceived its consumption to be a feature ofthe private lives of consumers. They also reported a lack of knowledge and time to address the topic.Knowing the patient for a long time was a brake to the drug dialogue.Based on the data obtained from the study, we developed a one-day training seminar for GPs. Theobjectives were to remove barriers to communication, to refresh doctors on current knowledge aboutcannabis, and to train them in brief intervention.A randomized controlled cluster trial were performed to evaluate the 12-month effects of briefintervention by the GP who had previously been trained among adolescents between 15 and 25 years ofage who used cannabis. After 1 year, cannabis use in the intervention group (IG) decreased from 30 [6-80] to 17.5 [2-60] and that in the control group (CG) decreased from 20 [5-40] to 17.5 [4-40]. The studydid not show any statistically significant results between the two groups after 1 year: p = 0.13. However,it did show a significant decrease in the number of joints smoked in the IG (p = 0.02), which was not thecase for the CG (p = 0.29). Also after 1 year, non-daily consumers smoked fewer joints per month in theIG (IG = 3 [0-15] versus CG = 10 [3-30], p = 0.01). In the 6th month, the study revealed a significantdifference in the multivariate analysis between consumption levels for those under 18 (IG = 12.5 [1-30]versus CG = 20 [12-60], p = 0.04).This study has also allowed an understanding of the complexity of the approach to the cannabisuse in primary care. The structuring of research on primary care is complex and requires methodologicalreflection that is essential for all future projects. Clinical research on cannabis is a delicate matterbecause of the illegality of its use and more general questions of research on illegal substances. Thedangers of cannabis are such that it is necessary to continue to encourage further work on this topic inorder to understand the behaviors of consumers and improve care regimes
Dokoui, Saturnin. "Systèmes de Santé dans la Caraïbe : Une étude des déterminants de la consommation médicale dans les petites économies insulaires de la Martinique et de la Guadeloupe". Antilles-Guyane, 2005. http://www.theses.fr/2005AGUY0588.
Testo completoChabot, Guylaine. "Déterminants psychosociaux et organisationnels de l’adoption d’un rôle infirmier redéfini en milieu scolaire primaire dans le contexte d’École en santé". Thesis, Université Laval, 2011. http://www.theses.ulaval.ca/2011/28434/28434.pdf.
Testo completoIosti, Pauline. "Les inégalités urbaines d’accès aux soins : une étude croisée des logiques d’organisation de l’offre et des trajectoires individuelles de recours aux soins dans la métropole de São Paulo". Thesis, Lyon, 2020. http://www.theses.fr/2020LYSE3039.
Testo completoInequalities in access to health care are generally studied through the territorial planning of the health care offer or through the socio-economic vulnerability of populations. However, recent works have contributed to renewing this theme by looking at health care utilization practices at an individual scale and using a longitudinal approach, with a special attention to urban areas. This work seeks to contribute to this renewed analysis of inequalities in access to health care. On the one hand, the purpose of this research is to examine the constraints induced by the spatial configuration of the health care systems and by the urban organization in emerging countries. On the other hand, it questions the way in which these constraints are bypassed or, on the contrary, reproduced in the individual trajectories of access to health care of urban populations. Two neighbourhoods of the municipality of São Paulo were studied, using a qualitative methodology combining non-participant observation and semi-structured interviews with health professionals and users of the public system. Two main results emerge from this thesis. Firstly, it shows the mixed effects of the organization of health care provision on inequalities in access to health care. Indeed, the organization of primary health care makes it possible to respond to local health needs, but the territorialization of care and the lack of a complex offer create significant constraints, particularly for the most vulnerable populations. Secondly, this study highlights the way in which prior social inequalities are reflected in individual health practices. Thus, individual trajectories show an unequal fluidity that illustrates the unequal capacity of individuals to act on these trajectories, in order to put them in line with their health care projects. Finally, it contributes to the identification of inequalities between urban populations in relation to the right to the city and to what the city has to offer
As desigualdades no acesso à atenção à saúde são um tema de estudo geralmente abordado, em geografia, pelo prisma do planeamento territorial da oferta ou da vulnerabilidade socioeconómica das populações. Porém, trabalhos recentes têm contribuído para a renovação deste tema, analisando as práticas de utilização da atenção à saúde à uma escala individual, com uma perspectiva longitudinal e com um novo interesse nas áreas urbanas. Esta tese procura contribuir para esta análise renovada das desigualdades no acesso à atenção à saúde. Ela estuda, por um lado, os obstáculos induzidos pela configuração espacial dos sistemas de saúde e pela organização das metrópoles dos países emergentes, e, por outro lado, a forma como estes obstáculos estão contornados ou, pelo contrário, reproduzidos nas trajetórias individuais de utilização da atenção à saúde das populações urbanas. Dois bairros do município de São Paulo foram estudados, utilizando uma metodologia qualitativa que combina observação não participativa e entrevistas semiestruturadas com profissionais de saúde e usuários do sistema público. Dois resultados emergem deste estudo. Primeiramente, ele mostra os efeitos mistos da organização da atenção nas desigualdades de acesso à saúde: a organização da atenção básica responde em parte às necessidades de saúde locais, mas a territorialização dos serviços de saúde e a carência da oferta complexa criam grandes obstáculos, particularmente para as populações as mais vulneráveis. Esta tese também revela que as desigualdades sociais se traduzem nas práticas de saúde individuais: as trajetórias de utilização da atenção estão desigualmente fluidas, o que reflete a capacidade desigual dos indivíduos à atuar sobre essas trajetórias para as alinhar com os planos de cuidados deles. Por fim, este estudo contribui para a identificação de desigualdades entre as populações urbanas no respeito ao direito à cidade e ao que a cidade tem para oferecer
Graber, Nils. "La vacuna, une innovation cubaine : immunothérapie du cancer, essais cliniques et soins primaires aux marges de la globalisation". Thesis, Paris, EHESS, 2019. http://www.theses.fr/2019EHES0122.
Testo completoSince its emergence in the 1980s, the Cuban biotechnology industry has developed pharmaceuticals designed to both export and integration into the national health system. Among innovative projects, cancer immunotherapy stands as one of the main areas. This domain of cancer therapy attempts to act upon immunological mechanisms to destroy or contain the tumour. Since 2010, some of these treatments have been made accessible for a wide-spread use in the country through the implementation of clinical trials expanded to primary health centres, called polyclinics, where notably general practitioners are working. The aim of this intervention is to transform (advanced) cancer into a chronic disease. It is an unprecedented intervention. At the international level, where immunotherapy also stands as a cutting-edge oncology treatment, these new drugs are only available at the hospital level, and wide access is threatened due to high prices. Combining ethnography with the study of collaborative networks, this work explores the innovation process in the development of cancer immunotherapy in Cuba, in its attempts to conciliate industrial policies and public health goals. The use of the local term vacuna is part of an examination of epistemic specificity as well as of the multiple understanding of cancer immunotherapy among industrial researchers, oncologists and primary healthcare professionals. The vacuna is taking shape through practices embedded within public institutions, which attempt to constantly conciliate conflicting dimensions, between economic and public health goals, biomedicine and primary care, respect of global norms and attention to local particularities, which is a source of multiple and modular innovations, likely to circulate among both global South and global North
Bertille, Nathalie. "Pharmaco-épidémiologie du traitement symptomatique de la fièvre chez l'enfant". Thesis, Paris 6, 2016. http://www.theses.fr/2016PA066341.
Testo completoFever is the first reason for consultation and drug treatment in children in primary care. Main drugs used in this indication are acetaminophen and a non-steroidal anti-inflammatory drugs (NSAIDs), ibuprofen. The objective of this thesis was to produce new knowledge on parents’ and healthcare professionals' (HPs) practices for the symptomatic treatment of fever in children with a focus on drug treatments. We used data from an observational, cross-sectional, national study performed from October 2007 to June 2008, where 1,534 general practitioners, primary care pediatricians, and pharmacists (participation rate 13%) included 6,596 children with fever < 48 hr. Analyses used notably multivariate multilevel models.Knowledge and practices of parents and HPs were frequently discordant with recommendations, notably for antipyretic measures. The main determinants of discordant practices were a low parental educational level, an older child’s age and the healthcare professional being a general practitioner. Among children who received acetaminophen, a large use of suppositories has been observed, including for non-vomiting and/or older children. Parents used more NSAIDs than HPs, and this gradient increased in clinical conditions potentially at risk of adverse effect. Our results highlight the need for health education interventions and continuing medical training on fever management in children, and enable to identify priority messages
Bucher, Sophie. "Diabète de type II et sujets de plus de 65 ans non institutionnalisés : prise en charge par les médecins généralistes en conditions de vie réelle - Suivi de cohorte". Thesis, Université Paris-Saclay (ComUE), 2018. http://www.theses.fr/2018SACLS111/document.
Testo completoPrevalence of type 2 diabetes mellitus is increasing worldwide and this trend is projected to persist because of the demographic shift (ageing population) and the obesity pandemic. Diabetes prevalence increases with age attaining 14% in people aged 65 years and over. Recent guidelines for the management of type 2 diabetes in the elderly recommend adjusting the therapeutic targets according to the patients’ health status. General practitioners (GPs) are the leading health professionals in charge of people with diabetes. In order to deliver appropriate medical care, GPs need to accurately assess the health status of their patients. However, in clinical practice it might be difficult for GPs to assess the health status of their patients routinely and they often rely on their intuitive clinical impression. The aim of this work was to describe the medical management of people aged 65 and older with type 2 diabetes followed up in the primary care. We particularly sought to assess the association between achieving the recommended personalized glycaemic targets (HbA1C) and the occurrence of major clinical events. Also, we sought to explore the relationship between GP estimation of the patient’ apparent age, as a simple tool to assess health status, and the risk of death in the next three years.Average age of all patients was 77.6±6.2 years and 56.6% were women. Most patients were independent and without cognitive impairment. Around 20% of patients had a high level of education. In the diabetes sub-cohort, the duration of diabetes was 11.3±8.7 years and the average HbA1c was 6.9±1.0%; 20% of patients had macrovascular complications and 33% had renal failure at baseline. Metformin was the most commonly used medication (62%) while insulin was used in 18% of patients. Concerning the association between glycaemic targets and major clinical events, data were available for 747 patients of whom 551 (76.8%) were in their recommended target. During the 3-year follow-up, 391 patients (52.3%) experienced a major clinical event but there was no difference between those who did not achieve their target and those who achieved it: odds ratio 0.95, 95% CI 0.69-1.31, p=0.76. These results suggest that a more permissive strategy to treat diabetes in the elderly could be implemented without increasing the risk of major clinical events. Among the 3434 included, 3427 patients were classified into one of three categories according to whether they looked their age or older or younger than their chronologic age. Depression, poor functional ability, heart failure and obesity were associated with a higher risk to look older whereas absence of depression, normal functional ability, higher educational level were associated with a higher risk of looking younger. Patients who looked their age or older had a higher risk of death than those who looked younger: hazard ratios 1.27 (95% CI 0.93–1.73) and 1.79 (95% CI 1.16–2.76), respectively (p=0.008). These results suggest that GPs integrate past medical history and deep knowledge of their patients to ascertain an apparent age, which may be considered as a marker of health status
Tennessel, Marianne. "Thérapies cognitivo-comportementales et médecine de ville : apports des concepts et techniques T.C.C. pour le médecin généraliste". Thesis, Toulouse 2, 2015. http://www.theses.fr/2015TOU20070/document.
Testo completoBackground: Mental health problems are prevalent in all countries and make up approximately one-third of consultations for general practitioners (GP) in large cities. In France, GPs provide service delivery to the majority of common psychopathological disorders. According to the National College of GP Educators, GPs are well suited to provide follow-up to these patients. Yet, many factors make this type of service delivery difficult: initial medical school training, the particularities of the French health system including a lack of networked service delivery, and poor communication between GPs and other health service providers, to name a few. These difficulties result in an over-usage of prescription psychotropic medications and this to the detriment of other types of therapies. Objectives: The objective of the current work is to better understand practices, attitudes and expectations of French GPs with regards to mental health treatment and the usage of CBT, an empirically validated approach to mental health problems that is still largely underutilized in France. Method: A study was implemented with the participation of French GPs. Results: The results show an overall need for better training of GPs. These results underline theoretical concepts in CBT and how they could provide a better foundation in both initial and continuing education of GPs, as well as how they could be integrated into the GP’s daily practice. Discussion: Limits of the work are presented along with a detailed inventory of CBT concepts that could be provided through an internet-based continuing education program for primary care doctors
Bayti, Lahcen. "Le nouvel ordre sanitaire international et la coopération sanitaire entre les pays en développement". Bordeaux 1, 1987. http://www.theses.fr/1987BOR1D003.
Testo completoThird world medical care, which for the moment is reserved for the elite can only be accessible to society admarged by focusing on prevention basic hight more efficient use of health care workers and an concentration on essential drugs. The consomption of drugs and medical services which preocuprises the industrial world only reaches on person in five. In the third world thebasic problem remains the satisfaction of elementary sanitary needs. The statement of alma ata is the map for health care in the xxst century. His technical mastery his demand for social justice, for health provision and his pleeding of urgent action in supported health care represent not only a recognition of it's importance at a global level but morexver the begining of health political care movment which aspires to provide basic health care to everyone by the year two thousand the declaration is witness to an exceptional international consensus on cooperation between countries so that all people are guaranteed of an acceptable level of health services. A key to the NOIH (new order of international health) is the drug industry. It is clevious that noih mesures must be in parallele with political educational, legal and the regulary mesure. This is the essential theme of our work. In conclusion only a furious coordination of all efforts will insure that essential medecine and vaccine are furnished to those who need them. Without this cooperation there can be no confidence in international health care cooperation between north and south or south and south