背景:大多数经济合作与发展组织(OECD)国家目前都面临着卫生转型的挑战,人口老龄化和慢性病的增加。有效和全面的初级保健(PHC)服务被认为是建立公平、和具有成本效益的医疗保健系统。发展护理协调,在更广泛的范围内,护理一体化,是高质量医疗保健服务的保证。中观水平的医疗保健系统的发展支持了这一雄心,并导致了PHC的领土结构过程。在法国,卫生领土和专业社区(HTPC)构成中观组织,来自同一领土的医疗保健专业人员(HCP)聚集在其中。我们进行了一项研究,以确定,在定性的步骤中,法国PHC领土结构的关键要素,然后,为了发展,在定量步骤中,这种结构的类型学。
方法:一项序贯探索性混合方法研究,其定性步骤使用多例方法,定量步骤作为来自多重对应分析(MCA)的主成分层次聚类(HCPC)。
结果:共对7个地区进行了定性探索。领土结构似乎取决于:过去在微观层面的合作,HCP和多专业结构之间的中观协调,独立专业人士的多样性,人口动态吸引年轻的专业人士,以及通过地方卫生合同(LHC)进行的公共卫生投资。类型学根据其结构水平确定了4个法国大陆领土集群:未结构化或非结构化(38.6%),具有结构化潜力(34.7%),结构化(25.3%)和已经结构化的地区(1.4%)。
结论:对地域结构的兴趣与中观级别医疗保健组织的挑战以及对综合护理的需求相一致。应使用地域结构的类型来了解其对访问的影响,护理质量,和医疗资源。
BACKGROUND: Most the Organization for Economic Co-operation and Development (OECD) countries are currently facing the challenges of the health transition, the aging of their populations and the increase in chronic diseases. Effective and comprehensive primary healthcare (PHC) services are considered essential for establishing an equitable, and cost-effective healthcare system. Developing care coordination and, on a broader scale, care integration, is a guarantee of quality healthcare delivery. The development of healthcare systems at the meso-level supports this ambition and results in a process of territorial structuring of PHC. In France, the Health Territorial and Professional Communities (HTPC) constitute meso-level organizations in which healthcare professionals (HCPs) from the same territory gather. We conducted a study to determine, in a qualitative step, the key elements of the territorial structuring of PHC in France and, then, to develop, in a quantitative step, a typology of this structuring.
METHODS: A sequential-exploratory mixed-method study with a qualitative step using a multiple case approach and a quantitative step as a hierarchical clustering on principal components (HCPC) from a multiple correspondence analysis (MCA).
RESULTS: A total of 7 territories were qualitatively explored. Territorial structuring appears to depend on: past collaborations at the micro-level, meso-level coordination among HCPs and multiprofessional structures, diversity of independent professionals, demographic dynamics attracting young professionals, and public health investment through local health contracts (LHCs). The typology identifies 4 clusters of mainland French territories based on their level of structuring: under or unstructured (38.6%), with potential for structuring (34.7%), in the way for structuring (25.3%) and already structured territories (1.4%).
CONCLUSIONS: Interest in territorial structuring aligns with challenges in meso-level healthcare organization and the need for integrated care. Typologies of territorial structuring should be used to understand its impact on access, care quality, and medical resources.