[Management of medication errors in general medical practice: Study in a pluriprofessionnal health care center]. / Gestion des erreurs médicamenteuses en médecine générale : étude en maison de santé pluridisciplinaire.

BACKGROUND: Medication errors are the most frequent medical care adverse events in France. Their management process used in hospital remains poorly applied in primary ambulatory care. OBJECTIVES: The main objective of our study was to assess medication error management in general ambulatory practice. The secondary objectives were the characterization of the errors and the analysis of their root causes in order to implement corrective measures. METHODS: The study was performed in a pluriprofessionnal health care house, applying the stages and tools validated by the French high health authority, that we previously adapted to ambulatory medical cares. RESULTS: During the 3 months study 4712 medical consultations were performed and we collected 64 medication errors. Most of affected patients were at the extreme ages of life (9,4 % before 9 years and 64 % after 70 years). Medication errors occurred at home in 39,1 % of cases, at pluriprofessionnal health care house (25,0 %) or at drugstore (17,2 %). They led to serious clinical consequences (classified as major, critical or catastrophic) in 17,2 % of cases. Drug induced adverse effects occurred in 5 patients, 3 of them needing hospitalization (1 patient recovered, 1 displayed sequelae and 1 died). In more than half of cases, the errors occurred at prescribing stage. The most frequent type of errors was the use of a wrong drug, different from that indicated for the patient (37,5 %) and poor treatment adherence (18,75 %). The systemic reported causes were a care process dysfunction (in coordination or procedure), the health care action context (patient home, not planned act, professional overwork), human factors such as patient and professional condition. The professional team adherence to the study was excellent. CONCLUSION: Our study demonstrates, for the first time in France, that medication errors management in ambulatory general medical care can be implemented in a pluriprofessionnal health care house with two conditions: the presence of a trained team coordinator, and the use of validated adapted and simple processes and tools. This study also shows that medications errors in general practice are specific of the care process organization. We identified vulnerable points, as transferring and communication between home and care facilities or conversely, medical coordination and involvement of the patient himself in his care.

[Multidisciplinary health houses and population: a (new) mode of organization for healthcare services?]. / Maison de santé et service à la population : pour une autre organisation de notre système de santé ?

In order to respond to the multiple paradoxes of current medical and healthcare services, some health professionals have chosen to operate as collective entities by creating multidisciplinary health houses. This trend is the practical outcome of an initiative that began in the early 2000s and that resulted in the creation of the Federation of health and healthcare houses (Fédération des maisons de soin et de santé), now known as the French federation of health houses and medical hubs (Fédération française des maisons et pôles de santé). Health houses offer a rich and varied range of prospects for improving the provision of healthcare services for local populations. Because of their multidisciplinary focus, health houses provide a comprehensive service for patients (i.e. treatment projects) with the possibility of articulating public healthcare policies around the coordination of prevention, education, screening and healthcare services (i.e. healthcare projects). They restore patients to a central position within the healthcare system and promote the provision of healthcare services aimed at ?fragile' populations. Socio-medical coordination also optimizes the use of hospitalization and the quality of home healthcare. To ensure the provision of such services, these new modes of organization require other means in addition to consultation fees. The "structure fee" (or forfait structure) is one such key element. The French federation of health houses and medical hubs is thus conceived in partnership with administrative and policy-making bodies on questions concerning access to healthcare, medical demography and the development of health houses and medical hubs.