RESUMO
The Mermoz multi-professional health center is a healthcare practice, including 24 professionals, on the outskirts of a major French metropolis. This article presents the challenges faced from the idea to the implementation of an interprofessional primary care offer. The difficulty of freeing up time for the construction of the common real estate and sanitary project has been overcome thanks to powerful motivations: the desire for more interprofessionality in practices that are sometimes fragmented, the need for support in the management of complex patients, the pleasure of being a group, and the improvement of healthcare. The horizontal mode of governance enabled a health care offer adapted to the specific health needs of a multicultural and precarious sector to be combined with a place for teaching and research.
La maison de santé pluriprofessionnelle Mermoz est un jeune cabinet comprenant 24 personnes, en périphérie d'une grande métropole française. Cet article présente les choix retenus et les défis relevés depuis l'idée de sa création à la mise en place d'une offre de soins de premier recours interprofessionnelle. Les difficultés pour détacher du temps dédié à la construction d'un projet commun, aussi bien immobilier que sanitaire ont pu être résolues grâce à la motivation pour l'interprofessionnalité, le soutien dans la prise en charge de patients complexes, le plaisir d'être un groupe, et l'amélioration des pratiques de soins. Le mode de gouvernance horizontal a permis de combiner une offre de soins adaptée aux besoins en santé spécifiques d'un quartier multiculturel et précaire avec un lieu d'enseignement et de recherche.
Assuntos
Atenção à Saúde , Relações Interprofissionais , Humanos , FrançaRESUMO
BACKGROUND: Smoking is a major public health problem. Although physicians have a key role in the fight against smoking, some of them are still smoking. Thus, we aimed to conduct a systematic review and meta-analysis on the prevalence of smoking among physicians. METHODS: PubMed, Cochrane, and Embase databases were searched. The prevalence of smoking among physicians was estimated and stratified, where possible, by specialties, continents, and periods of time. Then, meta-regressions were performed regarding putative influencing factors such as age and sex. RESULTS: Among 246 studies and 497,081 physicians, the smoking prevalence among physicians was 21% (95CI 20 to 23%). Prevalence of smoking was 25% in medical students, 24% in family practitioners, 18% in surgical specialties, 17% in psychiatrists, 16% in medical specialties, 11% in anesthesiologists, 9% in radiologists, and 8% in pediatricians. Physicians in Europe and Asia had a higher smoking prevalence than in Oceania. The smoking prevalence among physicians has decreased over time. Male physicians had a higher smoking prevalence. Age did not influence smoking prevalence. CONCLUSION: Prevalence of smoking among physicians is high, around 21%. Family practitioners and medical students have the highest percentage of smokers. All physicians should benefit from targeted preventive strategies.
