6533b830fe1ef96bd12977b3

RESEARCH PRODUCT

Physician pharmacist practice groups : consistency and feasibility in the primary healthcare system. Evaluation of an experiment in France

subject

description

The regulation of drug prescription by general practitioners is based on various mechanisms, but unlike other countries (Belgium, the Netherlands, Switzerland), it does not include practice groups between general practitioners and community pharmacists (GPMPs). This thesis analyses the coherence and, above all, the feasibility of such practice groups in our health system. The first chapter presents a macroeconomic and microeconomic analysis of the drug prescription by French general practitioners (GPs). It emphasises that it is an important target for regulatory policy because of its contribution to health expenditure but also its health impact, with prescriptions whose relevance could be improved. Furthermore, the heterogeneity of French GPs' prescribing practices remains significant, which can be explained by a multiplicity of determinants and prescribing logics that justifies a diversity of action levers to influence these practices. After analysing the tools used to regulate GPs' prescribing, chapter 2 shows that the GPMPs would be consistent with the current evolution of the community pharmacist's missions towards a more proactive approach in drug prescribing and with the reorganization of the primary healthcare system towards a more coordinated ambulatory sector. An analysis of the GPMPs set up in Belgium, the Netherlands and Switzerland details their configuration, operation and the results they have produced abroad. The evaluation of a GPMP experiment, of the research intervention type, is presented in chapter 3.This experimentation allowed, for the first time in France, to implement and operate GPMPs inspired by foreign models and adapted to our healthcare system.The evaluation of this experiment is based on a series of on-site observations, questionnaires and semi-structured interviews. It provides initial answers as to which model of GPMP should eventually be deployed, but also on the conditions that would facilitate the dissemination of such a device. If the satisfaction and adhesion of the professionals who took part in the experiment is attested, certain parameters appear to be favourable to the proper operation of a GPMP, in particular, its integration into the practice of coordinated exercise structures or the profile of the professionals (meeting leaders, participants). For the pharmacists leading these GPMPs, this new role is attractive but requires a very significant investment of time. The results of the evaluation allow to make recommendations if the GPMPs would become, in France, devices to be generalized. For their configuration, the following recommendations can be cited in particular, the opening of the animation to GPs, the provision of prescription data, support and pragmatic tools to prepare the sessions, as well as a freedom left to professionals to implement their GPMP and sessions. Changes in the healthcare system would also be levers for the dissemination of this practice, in particular by integrating it into the current deployment of the CPTS, establishing financial and/or professional recognition, and defining a coordinated support between several institutions and organizations (health insurance, professional organizations, learned societies, etc.).