Somme Dominique, Trouvé Hélène, Passadori Yves, Corvez Alain, Jeandel Claude, Bloch Marie-Aline, Ruault Geneviève, Dupont Olivier, de Stampa Matthieu
Université de Rennes 1, Faculté de médecine, Centre hospitalier universitaire de Rennes ; Centre de recherche sur l'action politique en Europe, UMR 6051, Rennes, France.
Fondation nationale de gérontologie, Paris, France.
Geriatr Psychol Neuropsychiatr Vieil. 2014 Jun;12(2):123-30. doi: 10.1684/pnv.2014.0464.
The concept of integrated services delivery, although dating from the 1990s, has only recently appeared in French public health policy. To clarify the concept and its adaptation to the reality of the French systems of healthcare and social services, the French Society of Geriatrics and Gerontology established an interdisciplinary working group. This article reports that group's findings according to three axes: the definition of integration, the objectives of this organizational approach and the means needed to achieve them. Analysis of the literature indicated that integration is a process that aims to overcome the fragmentation of services for vulnerable people. This process requires a multilevel approach, particularly concerning how to modify public policies and financing systems. Notably, all relevant levels need to develop shared processes, tools, resources, finance, interventions and returns on the latter. Indeed, this sharing is the ultimate proof of evolution towards integration. In the second part of the position paper, its authors have developed arguments that could lead professionals and non-professional caregivers to adopt integrated care as an answer to their aspirations. Policy-maker perspectives and politicians are also analyzed. Bearing in mind that integrated care necessarily will always involve a human component which may find expression during individual case-management; relations between integration and case managements are clarified. Finally, lessons learned from national and international experiments are examined. Results suggest that integrated care must to be accompanied by a local pilot. Results of recent experiments have shown that it is possible to initiate a dynamic towards integrated care in France and hence join the international movement towards adapting our healthcare systems to new challenges.
综合服务提供的概念虽然可追溯到20世纪90年代，但直到最近才出现在法国公共卫生政策中。为了阐明这一概念及其与法国医疗保健和社会服务体系现实情况的适配性，法国老年医学与老年病学协会成立了一个跨学科工作组。本文根据三个方面报告了该小组的研究结果：整合的定义、这种组织方式的目标以及实现这些目标所需的手段。对文献的分析表明，整合是一个旨在克服弱势群体服务碎片化的过程。这一过程需要采取多层次的方法，特别是在如何修改公共政策和融资体系方面。值得注意的是，所有相关层面都需要制定共享的流程、工具、资源、资金、干预措施以及后者的回报。事实上，这种共享是向整合发展的最终证明。在立场文件的第二部分，其作者提出了一些论点，这些论点可能会促使专业和非专业护理人员采用综合护理来回应他们的期望。同时也分析了政策制定者的观点和政治家的看法。要记住，综合护理必然始终涉及一个可能在个案管理过程中体现出来的人文因素；阐明了整合与个案管理之间的关系。最后，研究了从国内和国际实验中吸取的经验教训。结果表明，综合护理必须辅以地方试点。最近的实验结果表明，在法国有可能启动向综合护理发展的动态进程，从而加入使我们的医疗体系适应新挑战的国际运动。
