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Master Thesis

Le plan personnalisé de coordination en santé, un outil d’aide à la coordination des situations complexes en soins primaires : connaissance, adaptation au besoin et à la pratique des médecins généralistes de Savoie : enquête de pratiques professionnelles

Abstract : Background: Complexity in health care is an important issue linked to epidemiological and demographic transition, to health components and to the French social and health care system fragmentation. It needs global, personalized, coordinated and patient-centered approaches which take into account both economic and care access issues. Health pathways coordinated by GPs is the response chosen by the authorities. One of its tools is PPCS supported by MRSS ("Maison des réseaux de santé de Savoie") but which is not widely used. This study aims at discovering whether it is due to lack of knowledge or due to inadaptation. It also examines the role of MRSS. Method: It is a professional practices study led by a descriptive and analytic transversal observational and quantitative method. A self-answered questionnaire was sent to 424 liberal GPs involved in general practice. 202 answers were necessary. Results: 63 full answers have been collected. Every GP deals with complexity and encounter difficulties. About 25% of their patients are in complex situation. People aged above 60 are more likely to be in such situations. 95% of GPs have already been involved in coordination but without any helpful tool for 77% of them. 89% need help and their specific needs are not met. PPCS is unknown by 67% of GPs but could meet some needs and be helpful in patients care. It is not adapted because it is time-consuming, creating extra administrative complexity, and meetings are difficult to achieve. PPCS use can improve some of these matters. 87% of GPs know MRSS. It’s the main mean of communication. 70% of GPs wouldn’t use PPCS on their own but 86% of GPs would be willing with the support of MRSS. Financial outcome is a problem for 90% of GPs. Discussion: Despite the lack of statistical power, the results are consistent with literature regarding type of persons, their amount, and their foreseen increase. PPCS is the only global coordination tool, it could be appealing but is not well-known and marred by prejudices. MRSS must give long-term support and to reinforce communication targeting newly settled GPs, men, rural areas, and individual practices. Conclusion and prospects: Complexity in health care will increase consequentially. Our Health care system must change. To be sustainable, PPCS must be improved and must be considered with the couple GP-coordination support device “DAC”. It shouldn’t be a mere tool, it should be set for every case that needs coordinated acts whatever its complexity level and should actually be a “shared language” for all these cases. Professional changes toward coordinated practices can be a way to achieve goals, primary care is widely involved. Changes have to be supported.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03191061
Contributor : Jean-Hugues Morneau <>
Submitted on : Tuesday, April 6, 2021 - 6:53:45 PM
Last modification on : Sunday, April 11, 2021 - 3:17:08 AM
Long-term archiving on: : Wednesday, July 7, 2021 - 6:58:57 PM

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  • HAL Id : dumas-03191061, version 1

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Amélie Marty-Mauris. Le plan personnalisé de coordination en santé, un outil d’aide à la coordination des situations complexes en soins primaires : connaissance, adaptation au besoin et à la pratique des médecins généralistes de Savoie : enquête de pratiques professionnelles. Médecine humaine et pathologie. 2021. ⟨dumas-03191061⟩

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