Prise en charge par une équipe pluridisciplinaire des patients avec multiples vulnérabilités dans un service d'urgence

Introduction: Les centres d'urgence se trouvent régulièrement confrontés à des patients avec de multiples vulnérabilités médico-sociales qui recourent préférentiellement aux urgences pour y recevoir des soins de bases. Leurs fréquentes consultations contribuent à encombrer les urgences : dans notre service d'urgence entre avril 2008 et mars 2009, une étude ayant pour but de caractériser ces patients a montré que 14 % de l'ensemble des consultations ont été causées par 5 % des patients admis > 4 x/an.Matériel et méthode: Cohorte prospective des patients admis aux urgences et présentant des critères touchant > 3 axes de vulnérabilités sur les 5 axes reconnus habituellement (déterminants somatiques, de santé mentale, comportemental, social, de consommation de soins). Les patients inclus ont été soit signalés par le personnel médico-infirmier des urgences, soit dépistés par une équipe pluridisciplinaire (2 infirmières, 1 assistant social, 1 médecin) durant les jours ouvrables du 1.9.2010 au 14.12.2010.Résultats: 75 patients ont été inclus (65 % d'hommes). La moyenne d'âge était de 43 ans. 59 % étaient des migrants en provenance de : Europe (22 %), Afrique (22 %), Asie (12 %), Amériques du Sud (6 %) et du Nord (1 %). Les vulnérabilités les plus fréquentes étaient: somatiques 76 % (maladies aiguës/chroniques sévères 50 %, mauvaise adhérence thérapeutique 40 %), liées à la santé mentale 65 % (troubles anxieux et dépressifs 54 %), comportementales 80 % (addictions aux substances 73 %), sociales 93 % (absence de domicile fixe 31 %, absence d'assurance-maladie 15 %, barrières linguistiques 24 %, à l'assistance sociale 46 %) et consommation de soins (> 4 visites aux urgences/an 57 %, absence de médecin de premier recours 33 %). La charge de travail moyenne pour orienter ces patients vers des structures de santé primaire était de 3 heures/cas. Les interventions ont été d'évaluer le réseau de soins déjà impliqué (98 %), de réorienter dans le réseau ambulatoire (64 %) ou vers les services sociaux (37 %).Conclusion: Les vulnérabilités multiples sont relativement peu fréquentes dans notre service d'urgence mais leur complexité requiert des ressources qui dépassent ce que peuvent offrir des équipes de soins habituelles aux urgences. Une prise en charge individuelle par une équipe pluridisciplinaire est susceptible de fournir ces ressources et de réorienter ces patients vers des structures ambulatoires adaptées à leurs besoins.

Scheduled Service Versus Personal Transportation: The Role of Distance

This paper presents a theoretical and empirical analysis of the relationship be- tween frequency of scheduled transportation services and their substitutability with personal transportation (using distance as a proxy). We study the interaction between a monopoly firm providing a high-speed scheduled service and private transportation (i.e., car). Interestingly, the carrier chooses to increase the frequency of service on longer routes when competing with personal transportation because by providing higher frequency (at extra cost) it can also charge higher fares which can boost its profits. However, in line with the results of earlier studies, frequency decreases for longer flights when driving is not a viable option. An empirical application of our analysis to the European airline industry confirms the predictions of our theoretical model. Keywords: short-haul routes; long-haul routes; flight frequency; distance JEL Classification Numbers: L13; L2; L93

Meeting technologies and optimal trading mechanisms in competitive search markets

In a market in which sellers compete by posting mechanisms, we study how the properties of the meeting technology affect the mechanism that sellers select. In general, sellers have incentive to use mechanisms that are socially efficient. In our environment, sellers achieve this by posting an auction with a reserve price equal to their own valuation, along with a transfer that is paid by (or to) all buyers with whom the seller meets. However, we define a novel condition on meeting technologies, which we call “invariance,” and show that the transfer is equal to zero if and only if the meeting technology satisfies this condition.

Service offshoring and white-collar employment

This paper empirically studies the effects of service offshoring on white-collar employment, using data for more than one hundred U.S. occupations. A model of firm behavior based on separability allows to derive the labor demand elasticity with respect to service offshoring for each occupation. Estimation is performed with Quasi-Maximum Likelihood, to account for high degrees of censoring in the employment variable. The estimated elasticities are then related to proxies for the skill level and the degree of tradability of the occupations. Results show that service offshoring increases high skilled employment and decreases medium and low skilled employment. Within each skill group, however, service offshoring penalizes tradable occupations and benefits non-tradable occupations.

General Practitioners' willingness to pay for continuing medical education in a fee-for-service universal coverage health care system

Background: Sponsoring of physicians meetings by life science companies has led to reduced participation fees but might influence physician's prescription practices. A ban on such sponsoring may increase participation fees. We aimed to evaluate factors associated with physicians' willingness to pay for medical meetings, their position on the sponsoring of medical meetings and their opinion on alternative financing options. Methods: An anonymous web-based questionnaire was sent to 447 general practitioners in one state in Switzerland, identified through their affiliation to a medical association. The questionnaire evaluated physicians' willingness to pay for medical meetings, their perception of a bias in prescription practices induced by commercial support, their opinion on the introduction of a binding legislation and alternative financing options, their frequency of exchange with sales representatives and other relevant socioeconomic factors. We built a multivariate predictor logistic regression model to identify determinants of willingness to pay. Results: Of the 115 physicians who responded (response rate 26%), 48% were willing to pay more than what they currently pay for congresses, 79% disagreed that commercial support introduced a bias in their prescription practices and 61% disagreed that it introduced a bias in their colleagues' prescription practices. Based on the multivariate logistic regression, perception of a bias in peers prescription practices (OR=7.47, 95% CI 1.65-38.18) and group practice structure (OR=4.62, 95% CI 1.34-22.29) were significantly associated with an increase in willingness to pay. Two thirds (76%) of physicians did not support the introduction of a binding legislation and 53% were in favour of creating a general fund administered by an independent body. Conclusion: Our results suggest that almost half of physicians surveyed are willing to pay more than what they currently pay for congresses. Predictors of an increase in physicians' willingness to pay were perception of the influence of bias in peers prescription practices and group practice structure. Most responders did not agree that sponsoring introduced prescribing bias nor did they support the 2 introduction of a binding legislation prohibiting sponsoring but a majority did agree to an independent body that would centrally administer a general fund.

Employment effects of service offshoring: evidence from matched firms

This paper studies the effects of service offshoring on the level and skill composition of domestic employment, using a rich data set of Italian firms and propensity score matching techniques. The results show that service offshoring has no effect on the level of employment but changes its composition in favor of high skilled workers.

Service offshoring and the skill composition of labor demand

This paper studies the effects of service offshoring on the skill composition of labor demand, using novel comparable data for nine Western European countries between 1990 and 2004. The empirical analysis delivers three main results. First, service offshoring is skill-biased, because it increases the demand for high and medium skilled labor and decreases the demand for low skilled labor. Second, the effects of service offshoring are similar to those of material offshoring, both qualitatively and quantitatively. Third, the economic magnitude of these effects is not large.

Stress Perception in Public Organizations: Expanding the Job Demands - Job Resources Model by Including Public Service Motivation

Although stress has been a longstanding issue in organizations and management studies, it has never been studied in relation to Public Service Motivation. This article therefore aims to integrate PSM into the job demands-job resources model of stress in order to determine whether PSM might contribute to stress in public organizations. Drawing upon original data from a questionnaire in a Swiss municipality, this study unsurprisingly shows that "red tape" is an antecedent of stress perception, whereas satisfaction with organizational support, positive feedback, and recognition significantly decrease the level of perceived stress. Astonishingly, the empirical results show that PSM is positively and significantly related to stress perception. By increasing individuals' expectations towards their jobs, PSM might thus contribute to increased pressure on public agents. Ultimately, this article investigates the "dark side" of PSM, which has been neglected by the literature thus far.

IPH Response to Dept of Justice and Equality Review of the Code of Practice on the Sale and Display of Alcohol in Mixed Trading Premises

IPH responded to the Department of Justice, Equality and Defence review of the voluntary Code of Practice for the display and sale of alcohol in supermarkets, convenience stores and similar mixed trading outlets. The voluntary Code was introduced in 2008 as an alternative to the statutory rules for structural separation of alcohol products in mixed trading outlets which are set out in section 9 of the Intoxicating Liquor Act 2008. Interested bodies and individuals were invited to submit comments on the Compliance Report for 2011 and on the effectiveness of the voluntary approach to structural separation by 20th December 2011. The Minister said he intended to also seek the views of the Minister for Health and the Joint Oireachtas Committee on Justice, Defence and Equality before reaching any decision on whether to bring the statutory rules in the 2008 Act into operation.

IPH response to DHSSPS Draft Service Framework for Mental Health and Wellbeing

This is  the IPH response to the Department of Health, Social Services & Public Safety's Draft Framework for Mental Health and Wellbeing

Service Framework for Cardiovascular Health and Wellbeing (2014)

Welcome to the easy access version of the Service Framework for Cardiovascular Health and Wellbeing. åÊ It sets out what you can expect from the Health and Social Care (HSC) services in Northern Ireland if you have a cardiovascular illness or you care for someone who does.

Service Framework for Older People (PDF 1MB)

Easy Access Version