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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.
Pełny tekst źródłaThe 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
Li, Lingwei. "Les places respectives de la médecine chinoise et de la médecine occidentale dans le droit chinois entre 1840 et 1982". Thesis, Aix-Marseille, 2017. http://www.theses.fr/2017AIXM0276/document.
Pełny tekst źródłaFor millennia, Chinese medicine has been of some renown. However, during the period going from the first opium war of 1840 to the promulgation of the constitution of 1982, this medicine has slowly declined. This change is mainly due to the radical mutation of Chinese society on its whole, and to its increasing confrontation with western culture and medicine. Successive political regimes have tried to set up diverse health systems, which they modernized or westernized, in order to remedy the delicate health situation and relieve some burden from existing institutions. They either openly supported Western medicine, even to the point of wanting to abolish its Chinese counterpart, or tried to stimulate some form of collaboration between the two medicines. Based on this history of clashes and forced cohabitation, and on the specific aspects of each of them, it seems a sound goal to proceed to a deeper collaboration between these two medicines, to help and manage public health more efficiently. Indeed, this collaboration could in itself better the current health system, would stimulate medical activity, could reduce healthcare costs and finally should improve global health and wellbeing of the Chinese population. But of course, it is first and foremost a pressing duty to enhance the current status of existence and state of development of Chinese traditional medicine
Duconge, Jean-Patrick. "Les soins de santé primaires en Guinée". Montpellier 1, 1992. http://www.theses.fr/1992MON11137.
Pełny tekst źródłaGbabode, Placide. "Le système sanitaire et les soins de santé primaires en République centrafricaine". Bordeaux 2, 1993. http://www.theses.fr/1993BOR2M036.
Pełny tekst źródłaSt-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.
Pełny tekst źródłaWey, John. "Les soins de santé primaires et la mobilisation paysanne au Nigéria : exemple du shomolu". Nice, 1996. http://www.theses.fr/1996NICE2042.
Pełny tekst źródłaAbstract: 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.
Pełny tekst źródłaAim: 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.
Pełny tekst źródłaChaneliere, 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.
Pełny tekst źródłaPrimary 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.
Pełny tekst źródłaThompson-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.
Pełny tekst źródłaClinically 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.
Pełny tekst źródłaIn 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
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.
Pełny tekst źródłaDisability 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.
Pełny tekst źródłaBrunat, 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.
Pełny tekst źródłaThe 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.
Pełny tekst źródłaKaluma, 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.
Pełny tekst źródłaFerron, 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.
Pełny tekst źródłaThis 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.
Pełny tekst źródłaAfin 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.
Pełny tekst źródłaPharmacists’ 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.
Pełny tekst źródłaRioux-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.
Pełny tekst źródłaDucos, Jean. "L’économie de la médecine libérale". Paris 9, 2010. https://bu.dauphine.psl.eu/fileviewer/index.php?doc=2010PA090023.
Pełny tekst źródłaThis 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.
Pełny tekst źródłaTchicaya, 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.
Pełny tekst źródłaOver 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.
Pełny tekst źródłaBackground: 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.
Pełny tekst źródłaAccording 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.
Pełny tekst źródłaThe 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.
Pełny tekst źródłaTitle: 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.
Pełny tekst źródłaMazaudier, 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.
Pełny tekst źródłaBordas, 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.
Pełny tekst źródłaDonnat, 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.
Pełny tekst źródłaIs 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.
Pełny tekst źródłaSaint-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.
Pełny tekst źródłaPay 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.
Pełny tekst źródłaMéthode: 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.
Pełny tekst źródłaTurcotte, 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.
Pełny tekst źródłaLes 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.
Pełny tekst źródłaA 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
Chabot, 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.
Pełny tekst źródłaIosti, 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.
Pełny tekst źródłaInequalities 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.
Pełny tekst źródłaSince 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.
Pełny tekst źródłaFever 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.
Pełny tekst źródłaPrevalence 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.
Pełny tekst źródłaBackground: 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.
Pełny tekst źródłaThird 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
Ghandour, El Kebir. "Les facteurs influençant l'adoption du dossier de santé électronique personnel (DSE-P) pour le suivi et la gestion des maladies chroniques en première ligne de soins au Québec". Doctoral thesis, Université Laval, 2018. http://hdl.handle.net/20.500.11794/28256.
Pełny tekst źródłaIn Quebec, My Digital Primary Health Care (MDPHC) is the first electronic personal health record (ePHR) implementation project funded by the province. However, little is known about ePHR implementation, adoption and use in healthcare organizations in Quebec as well as there is little information on their potential impacts. Mainly, adoption is a major concern for ePHR implementation. Indeed, despite the numerous potential benefits associated with ePHR use, the literature reports low adoption rates. Therefore, this research aimed to explore the perspective of chronically ill patients, professionals and managers regarding ePHR adoption, and to examine perceived barriers and facilitators to adoption among users enrolled in an ePHR pilot project in a primary care organization in Quebec. We conducted a case study with mixed method research, predominantly qualitative, in a primary care organization that has implemented an ePHR as part of the MDPHC project funded by the Government of Quebec. In this research, the strategies for data collection were: 1) a quantitative survey carried out in the project pre-implementation phase within a family medicine group, 2) individual semi structured interviews and 3) documentary analysis in order to describe the project context and evolution. We mainly conducted a descriptive statistical analysis of the quantitative data, and a content analysis of data collected during individual interviews and from project documents. Fifty-seven participants completed the questionnaire, and 43 people, including 29 patients (18 users and 11 users), 11 professionals and three managers were interviewed. We identified the most salient facilitators and barriers to ePHR adoption by chronically ill patients and professionals, and to ePHR integration into clinical practice. The main factors are patients’ and professionals’ individual characteristics; the quality of the patient-professional relationship and the clinical practice context in primary care organizations; the characteristics of the offered technology and organizational conditions and support to ePHR use. The contribution of our research was at two levels. First, we were able to identify the most salient conditions that can influence ePHR adoption by chronically ill patients and healthcare professionals and we verified their relevance to the context of the primary care in Quebec. Also, we applied for the first time a new conceptual framework for the analysis of the organizational conditions influencing ePHR adoption by professionals based on a new practical approach that links ePHR adoption by professionals to the project effectiveness of the implementation. ePHR represents a promising tool to support a more active role for chronically ill patients in their individual health condition and healthcare management in collaboration with clinical teams. Moreover, by improving chronically ill patients’ experience of care and increasing their interactions with professionals, ePHR seems to have a prominent place in primary care organizations in Quebec. However, the implementation and adoption of such tools have to be considered under new organizational model involving the patient participation and his collaboration with the clinical team, which it is the main premise. However, such an approach must rely on a change in culture, and requires rethinking several clinical and organizational processes and a negotiation and redefinition of roles and responsibilities of actors in the health network for a new patient- clinical team partnership where ICT should also be adapted to support new practices and a reorganization of the services. This would then lead to focus on the development and integration of informational and communicational innovative tools much more steeped in the clinical and organizational realities. ePHR can be complementary to the electronic medical record, the primary health care professionals’ working tool, with which it is the same set. Keywords: Electronic Personal Health Record, Adoption, Implementation, Chronic Disease Management, Primary Health Care, Case Study, Quebec.
Fournier, Cécile. "Les maisons de santé pluriprofessionnelles, une opportunité pour transformer les pratiques de soins de premier recours : place et rôle des pratiques préventives et éducatives dans des organisations innovantes". Thesis, Paris 11, 2015. http://www.theses.fr/2015PA11T011/document.
Pełny tekst źródłaThe delivery of primary care in multi-professional health care centres (MSPs) has met with growing interest over the past few years. These types of care organisations have been presented as a solution to the challenges associated with population ageing, the increasing prevalence of chronic diseases, the rise of inequalities in healthcare and of healthcare expenditures. MSPs contribute to the questioning of the French health care system, based historically on a curative and hospital-centred model complemented by a self-employed, isolated and city-concentrated system of medical practice. The need to give primary care a central place in the system has become an objective shared by public institutions and by some self-employed healthcare professionals (HCPs). It is associated with the aim of restructuring primary care in order to emphasize a prevention-based approach, in a more collective, coordinated, population-based and territory-based approach of public health. How are primary care practices being transformed within these MSPs? In the dynamics observed, what are the place and role played by preventive and educational practices? These questions are explored with a posture of “committed” research, based on a methodological and political reflection, involving medical, public health and sociological approaches. An analysis of the literature enables this research to place the development of MSPs in a continuum of organisational innovations, favoured by the decreasing number of doctors, the uneven distribution of HCPs and the territorialisation of healthcare provision. In order to seize - in a simultaneous and dynamic way - the current transformations and arrangements observed in MSPs and the meaning they have for the actors involved, the research is based on an ethnographical monograph of a project of MSP followed over a long period, and on interviews held with actors practicing in four different MSPs. The sociology of innovation enables us to highlight the “ways of doing things” and the translation operations that help to weave together the development of coordinated practice in MSPs and the implementation of prevention and educational measures involving actors not accustomed to working together. Moreover, the interactionist perspective in sociology allows us to apprehend the difficulties met by the actors in their daily practice, their aims and their arguments in favour of a new organisational framework, as well as the diversity of the different forms of their engagement and the underlying social dynamics. MSPs and initiatives of prevention and patient education implemented in these institutions appear as effective political instruments to “put professionals in movement” around objectives and organisations that have to be built up together, following several paths. With these flexible innovative devices, multi-professionality and preventive practices feed mutually on each other, contributing to the structuring of a primary care system on a territorial basis, and to the emergence of a wider definition of prevention. However, these transformations meet important constraints. On one hand, the reinvention of a collective medicine, against which the self-employed medicine has been opposed for over a century, collides with the weight of a heavy professional logical system, questioning the possibility of an extension of these new organisations. On the other hand, the scale of the preventive and educational supply of care is limited by the available resources as well as the choices made by the actors- and by the low rank given to patients. These results question the capacity of the actors to overtake the logical professional approach in order that they integrate from now on a public health logical approach with a preventive and educational aim. They also question the will of the actors to integrate a health-promoting approach, than could tackle the politics of intersectoral actions to affront the determinants of health inequalities
Zitoun, Sarah. "Conduite automobile du sujet âgé : danger potentiel ou vieillissement réussi ?" Electronic Thesis or Diss., université Paris-Saclay, 2023. http://www.theses.fr/2023UPASR034.
Pełny tekst źródłaIn a worldwide aging population, older drivers account for a large part of road traffic, since multimorbidity and polypharmacy (in particular with Potentially Driver-Impairing (PDI)-drugs) are frequently observed among them. Yet, driving allows to preserve autonomy and social life, known as criteria of Successful Aging (SA). This work analyses the french S.AGES cohort data, which includes 3,700 community-dwelling subjects aged ≥ 65, suffering from type 2 diabetes (T2DM), chronic pain or atrial fibrillation (AF). The objectives are to analyse factors associated with PDI-drug consumption among drivers, to seek an association between driving and SA and to perform a survival analysis. More than 20 % (n=373) of drivers took at least one PDI-drug, especially hypnotics, an anxiolytic and analgesics. Drivers taking PDI-drugs had more often chronic pain (OR [95%CI]=2.30 [1.54-3.46]), history of depressive disorder (4.28 [3.00-6.14]) and polypharmacy (4.32 [2.97-6.41]), and less often T2DM (0.54 [0.37-0.79]), and AF (0.48 [0.32-0.71]). Conversely, they had a lower Activities of Daily Living score (0.34 [0.17-0.68]). SA was associated with driver status (1.94 [1.36-2.77]). Car driving was associated with greater survival at 3 years only in bivariate analysis (HR=0.67 ; p=0.001). These results call to frequently assess and reassess seniors’ prescriptions and to maintain their mobility as much as possible, by regular screening of driving skills, developing specific rehabilitation programs, and improving public transport services and driverless vehicle technologies
Le, Floch Bernard. "Quels facteurs positifs déterminent l'attrait vers la médecine générale et le maintien dans leur pratique clinique ?" Thesis, Brest, 2018. http://www.theses.fr/2018BRES0036/document.
Pełny tekst źródłaIntroduction: OECD countries, including France, face a shortage of general practitioners. Many research studies the negative sides of the specialty to explain it. The research project of the EGPRN was to highlight the factors of satisfaction of the general practitioner, in the participating countries. The research hypothesis of this project is that there must be well being and motivated GPs and that these positive factors could be used to promote attractiveness to General Medicine and maintenance in clinical practice.Method: The first step of this thesis was the realization of a systematic review of the literature to list the various factors of satisfaction of general practitioners already studied. For the second stage, qualitative studies by semi-structured interviews or focus groups were then conducted with general practitioners in the eight participating countries. The third step consisted of a consensus search by the Delphi method then hierarchization by nominal group.Results: Qualitative surveys by semi-structured interviews or focus groups conducted in the participating countries were used to interview 183 general practitioners interviewed in the eight countries.Codes from verbatim were created a "codebook" comprising 31 items that were classified into 6 themes: the general practitioner as a person, the skills specific to the profession of general practitioner, the positive organization of the profession of doctor generalist, the doctor-patient relationship, the teaching of general medicine and the factors that support the general practitioner.Conclusion: The results of the consensus study showed that to recruit in general practice it is necessary to develop care coordination, patient-centered approach, teaching and internship control and to pay attention to factors organization