Anne Vega

Créer des liens : les relations soignants-soignants dans les réseaux de soins informels

BACKGROUND During the last years, the french health system has been developing formal health networks. So, it was necessary to study informal health networks as <<social actors>> networks. More precisely, we studied the nature of relationships between various stakeholders around general practionners wich are commonly considering as the <<pivot>> stakeholder of the health system private sector. METHODS Fieldwork (ethnography based on direct observations and interviews) was conducted between October 2002 and april 2004, in the South-East of France. Ten monographs of general practioners offices were achieved in a rural area; then, we achieved fieldwork of the informal health networks identified. RESULTS There is a cultural frame wich is common to all private professionals. This frame includes a triple ideal (teamwork built up the hospital model, independance, and an relational approach with patients). This frame does not square with the real practices. In fact, regulation mechanisms preserve the balance of relashionships between professionnal groups, by restricting/promoting exchanges and complex alliance strategies. These mecanisms include: (1) a few professionnals rule as disponibility (to the patients and to the professionnals), as communication about patient, as patients reference, as obligation to communicate between professionals; (2) some constraints such as territory superposition and competition with other professional groups; (3) some needs for: rileiving (of emotions and worries connected to work), sharing (decisions, responsabilities), of delegation (medical treatment, practices), protection against social and legal risk through the creation of trust relationships. These trust relationships are based on several logics (affinity, solidarity, similarity). The study shows the major place of the patient who is often the main organizer of his network, and even though he makes an important structuring work between medical staff, and an information transfer (on his diagnosis, on his treatment, and << on >> professionals). The patients role of <<coordination>> is underestimated. CONCLUSION The results show that in studied informal networks, professionnals do not have a transversal view of the patients care management. This is due to the lack of knowledge of each health agent about the work of others, to the symbolic compartmentalization between professional groups, and because the difficulties encountered (i.e. burden work).

What role does the general practitioner in France play among cancer patients during the initial treatment phase with intravenous chemotherapy? A qualitative study

Abstract Background: France’s ethical and legal principles place general practitioners (GPs) at the forefront of cancer patient management, coordination, and follow-up. The objective of this study was to determine the actual role of GPs in the follow-up phase as well as patient perspectives on their GPs. Method: A multidisciplinary group of researchers conducted this qualitative study based on in-depth interviews of 50 patients managed at two cancer centres. A content analysis method was used to analyse the study data. Results: According to the patients interviewed for this study, their GPs were relatively ineffective at managing medical problems related to cancer by comparison with their oncologists. Nonetheless, the patients had all consulted their GPs during the interval between the diagnosis and our interview. Reasons given for consulting their GPs included administrative matters, psychological support, reassurance, and advice, but also to a lesser extent, medical management. Conclusion: Patients’ perspectives called attention to two aspects of the role of GPs in the French healthcare system: (a) the importance of GPs within an effective system for managing cancer patients, and (b) for some patients, GPs’ relative lack of medical skill compared to oncologists.

Lutter contre les inégalités sociales de santé : une mission impossible ?

Plus une personne se situe dans le bas de l’echelle sociale, plus sa sante est mauvaise. Amorcees avant la crise de 2008, les inegalites sociales de sante (ISS) restent importantes en France. Elles sont attestees dans la plupart des pays europeens – Suisse comprise –, et ni la qualite du systeme de soins ni la seule intervention des medecins ne suffisent a les reduire. Car leurs causes sont… les inegalites sociales en general.