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Prospere – Multidisciplinary research partnership on organizing primary care

2009/2012 contract
Coordinator: Nathalie Pelletier-Fleury (Cermes3)

Context: In France today, the outpatient-care sector and particularly the primary-care sector are facing rapid and contradictory evolutions in the care supply and demand. Primary care, mainly provided by general practitioners and by other non-medical health professionals (nurses, physiotherapists, etc.) is being reorganized. This process has stepped up since the 2004 law on health insurance was enacted.The articulation of professional reorganization dynamics with the evolution of patients’ needs and demands, as well as the requirement to territorialize primary care call for new regulation mechanisms (incentives, team work, new practices), which raises many questions in a field where research has thus far been scarcely developed.

Goals and methods: The goal of our team aimed both to produce knowledge on the various forms of organization of primary care and ultimately to constitute the conditions of collective and multidisciplinary development of knowledge on the functioning and structuring of the primary-care system in France. The team was made up of researchers from a variety of disciplines in Cermes3, Irdes and the SFMG.Four specific goals guided our research program over four years, constituting four research areas articulating several research operations. The first was to continue to develop a framework to analyze the different forms of primary-care organization adapted to the French context from the point of view of evaluative research on the links between these forms of organization and their results. The second aimed to analyze the organized forms of primary care by using the concepts and methods of microeconomics through an analysis of incentives to suppliers, the methods used to reveal users’ preferences, and the medical-economic evaluation. The third aimed to analyze the organized forms of primary care by using the concepts and methods of sociology as applied to the redistribution of roles and activities among professionals and users in a micro and macro approach to the care system. The fourth was to continue building a research tool consisting of a database matching medical data with reimbursement data in order, on the one hand, to test the methods and indicators used to analyze the different forms of primary-care organization and in addition, to constitute a control sample for the evaluative research work on primary-care organization. The researchers in the team were each working on particular operations connected with their own interests, their methods, and their disciplinary field. Nonetheless, the multidisciplinary nature of our work was operationalized through the constitution of common material made up of a contrasted sample of forms of organization of primary care (nursing homes, health centers, group offices, individual offices), everyone’s participation in building a framework to analyze the different forms of primary-health organization (Areas 1 and 4) and in a collective discussion of the assumptions, methods, and results of each research operation (Areas 2 and 3).

Results: Our work provided results that can be used in the short run, on the one hand to contribute to the definition of the expectations and goals of experimental initiatives or of the generalization of remuneration methods and of specific forms of organization, or both, and on the other hand, to contribute to the evaluation of experiments by using analysis frameworks produced and tested in a comparative perspective. The results of these research operations have been circulated through different media in order to transfer the knowledge produced to the actors of the care system and to exploit the work from the academic point of view.