Concretely, this presupposes the coordinated and concerted intervention of health and social professionals , both in the city and in health, medico-social and social establishments, in private practice, in nursing homes or health centers, in a network of health… As well as taking into account, for each patient, determining factors such as hygiene, lifestyle, education, the professional environment and the environment.
This is all the more so as in recent years, a consensus has emerged on the challenges that our health system must face: the extension of life expectancy and the development of chronic diseases – which constitute a considerable upheaval – or even inequalities social and territorial disparities, which are still a reality for too many French people.
Therefore, 3 levels of support are identified:
– health pathways , which articulate care with, upstream, health and social prevention and, downstream, medico-social and social support, maintenance and return to home care
– pathways , which allow access to first-line consultations and, when necessary, to other places of care: scheduled or unscheduled hospitalization (emergency), home hospitalization (HAD), follow-up and rehabilitation care (SSR), long-term care unit (USLD) and accommodation establishments for dependent elderly people (EHPAD)
– Life courses , which consider the person in his environment: family and entourage, schooling, prevention of professional withdrawal, reintegration, housing, etc.
Objective: to allow the French to receive “the right care by the right professionals in the right structures, at the right time “. This, while benefiting from equal access to health, clear, accessible, complete and quality care, as well as a rationalized and more efficient health and social organization. And above all, meet the demand of patients and their families by developing care and services. Indeed, pathway medicine leads to a profound paradigm shift: the adaptation of care, relationships between professionals, structures and resources around patients, their entourage and their needs… and no longer the reverse .
Indeed, the pathways are a revolution, which places patients at the center of care. They are no longer the ones who have to adapt to the health system – organizations or structures – but to the system of organizing themselves to meet their needs.
Our health system, organized around the hospital, is remarkable for treating acute episodes of a pathology: on the other hand, it becomes too complex, too compartmentalized when it comes to providing long-term care for people who are aging or suffering from chronic diseases, For example. Hence the need to invest in “primary care” – also called local or first-line care – and to support the “ambulatory shift” announced in the law to modernize our healthcare system .
This ambulatory shift represents the transition from a hospital-centric system to a system that makes doctors and the primary care teams formed around them both pivots and coordinators of pathways between city structures – private practices, homes and health centers – and hospitals, medico-social and social establishments.
Primary care professionals are responsible for this development, primarily treating physicians and, whenever indicated, other specialists and medical auxiliaries. At their level, hospitals must refocus on their primary mission – care and not accommodation – with more appropriate hospitalizations, lengths of stay more in line with patient needs and a more graduated care offer.
This involves changes:
– within health establishments , by transferring to day hospitalization some of the short-term hospitalizations for which accommodation is no longer justified thanks to technical progress. The development of day surgery has shown the way: this development will continue for certain medical or psychiatric activities. In addition, certain activities carried out in day hospitals without necessity or real benefit for the patients can be replaced by long consultations, or even care carried out in town. In addition, the length of stay in surgery for certain operations can be shortened, thanks to rapid rehabilitation procedures.
– within city structures, who must organize themselves to provide quality and safe care for patients who will not be hospitalized or will be for a shorter period. This requires better cooperation between professionals as well as the development of HAH and alternatives to hospitalization such as telehealth .
A necessity: cooperation between professionals
Building pathways for patients in a context of constrained resources – including human resources – encourages a review of the practices of professionals, their relationship, their organization, both in the hospital and outpatient sectors . These new practices are mainly encountered in the follow-up of chronic diseases and, increasingly, in the context of consultations or technical procedures.
Coordinated and multi-professional exercise – bringing together general practitioners and specialists, pharmacists, nurses, masseurs-physiotherapists, podiatrists-podiatrists, etc. – finds privileged ground within ambulatory structures such as homes and health centers , for which the Ministry pursues a determined policy for their massive development. Health
networksare also part of the main coordination mechanisms involved in patient pathways. The law on the modernization of our health system plans to pool them within territorial support platforms (PTA) with all the medical and social coordination systems, with a view to providing solutions to attending physicians to organize the pathways health.