Friday, November 13, 2009

Medical Homes in France. A Demonstration and an Evaluation

The concept of the "Medical Home" has become a central theme in calls for health system reform in the US.  The medical home idea is familiar to anyone who has followed the development of primary care as an organizing concept.  The medical home emphasizes coordinated care and the use of multidisciplinary teams.  Primary care group practice in France has not developed as rapidly as it has in the US and the use of multidisciplinary teams involving practitioners other than physicians has not been readily embraced in the French system.

However, France is facing an emerging problem in access to care for smaller towns and villages as the number of physicians falls compared to the population and the trend to choose practice in urban areas and the south of France exacerbates geographic inequalities.  The reforms anticipated by the HPST law (Hopital, Patient, Santé et Territoire) include a greater emphasis on primary care that makes use of multidisciplinary teams.  Several demonstration projects have been fielded to test these concept in France.  One of them, PROSPERE (Partenariate pluridisciplinaire de recherché sur l'organisation des soins de premiere recours) is evaluating demonstrations of new organizational forms for primary care in selected regions and communities. A recent report described the results of a case-control evaluation of a medical home demonstration in the regions of Burgundy and Franche-Comté.  The medical homes were activated in 2007 and 2008 and their practices compared to other generalist practices in the same service areas for the medical homes.  The study included 35,198 medical home patients treated by 32 general practitioners and 231,021 control group patients treated by 229 generalists.

From the Abstract of the report: "This study confirms that these structures, when compared to the average practice in general medicine, allow better balance between personal life and clinical practice. The medical homes offer other advantages: increased accessibility due to longer opening times, effective cooperation between professionals, particularly between GPs and nurses, and a wide range of health care options. Further, The quality of care for patients with type 2 diabetes appears to be better in the medical homes despite the high heterogeneity of results. At this stage, we cannot conclude that costs are either higher or lower for patients cared for in the medical homes than in regular local practice."

An Exploratory Evaluation of Multidisciplinary Medical Homes in Franche-Comté and Burgundy. by Yann Bourgueil, Marie-Caroline Clement, Pierre-Emmanuel Couralet, Julien Moques, Aurelie Pierre.

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