How Primary Healthcare Sector is Organized at the Territorial Level in France? A Typology of Territorial Structuring.

BACKGROUND: Most the Organization for Economic Co-operation and Development (OECD) countries are currently facing the challenges of the health transition, the aging of their populations and the increase in chronic diseases. Effective and comprehensive primary healthcare (PHC) services are considered essential for establishing an equitable, and cost-effective healthcare system. Developing care coordination and, on a broader scale, care integration, is a guarantee of quality healthcare delivery. The development of healthcare systems at the meso-level supports this ambition and results in a process of territorial structuring of PHC. In France, the Health Territorial and Professional Communities (HTPC) constitute meso-level organizations in which healthcare professionals (HCPs) from the same territory gather. We conducted a study to determine, in a qualitative step, the key elements of the territorial structuring of PHC in France and, then, to develop, in a quantitative step, a typology of this structuring. METHODS: A sequential-exploratory mixed-method study with a qualitative step using a multiple case approach and a quantitative step as a hierarchical clustering on principal components (HCPC) from a multiple correspondence analysis (MCA). RESULTS: A total of 7 territories were qualitatively explored. Territorial structuring appears to depend on: past collaborations at the micro-level, meso-level coordination among HCPs and multiprofessional structures, diversity of independent professionals, demographic dynamics attracting young professionals, and public health investment through local health contracts (LHCs). The typology identifies 4 clusters of mainland French territories based on their level of structuring: under or unstructured (38.6%), with potential for structuring (34.7%), in the way for structuring (25.3%) and already structured territories (1.4%). CONCLUSION: Interest in territorial structuring aligns with challenges in meso-level healthcare organization and the need for integrated care. Typologies of territorial structuring should be used to understand its impact on access, care quality, and medical resources.

Prevalence and socioeconomic factors associated with non-utilization of dental care in Lebanon: A nationwide cross-sectional survey.

OBJECTIVES: To assess the prevalence of non-utilization of dental care in Lebanon and associated socioeconomic factors and self-care behaviours. METHODS: A nationwide, quantitative, survey-based study was conducted by trained interviewers with Lebanese residents aged ≥18 years between July and September 2019. Univariate analyses were performed using Pearson Chi Square test or the Fisher's exact test followed by a binary logistic regression using the SPSS Version 25. RESULTS: Of the 1070 participants, 247 (23.1%) did not utilise any type of healthcare and 144/247 (58.3%) did not utilise dental care. The prevalence of non-utilization of dental care was estimated at 13.5%. Only 4.7% of the respondents consulted their dentist in the past year, among which 53% cited pain/emergencies as the reason for their consultation. Socioeconomic factors associated with the non-utilization of dental care were lack of social medical insurance (OR, 0.49 [95% CI, 0.31 to 0.79]) and long waiting time/patient time restriction (OR, 2.05 [95% CI, 1.26 to 3.35]). On the other hand, facilitators for utilization of dental care included ethical standards/personal qualities of the dentist (OR, 0.53 [95% CI, 0.32 to 0.88]) and convenient cost with respect to the individual's economic status (OR, 0.28 [95% CI, 0.18 to 0.43]). CONCLUSION: This study suggests that dental care practices in Lebanon, including the non-utilization of dental care, are suboptimal. Measures such as reducing sugar and tobacco consumption, providing information on oral hygiene, and using fluoride products are inexpensive; however, implementing these measures may take substantial time and input by multiple stakeholders.

Denormalization of tobacco and its industry by civil society: Implementation and evaluation of the "Pouvoir de vivre" campaign by ACT ­ Alliance Contre le Tabac (Alliance Against Tobacco) / Dénormalisation du tabac et de son industrie par la société civile : mise en œuvre et évaluation de la campagne « Pouvoir de vivre ¼ par l'ACT ­ Alliance contre le tabac

This article examines the "denormalization" approach, which has gradually gained ground in the field of tobacco control. This process encompasses a wide range of practices and aims to renew tobacco control by extending its scope beyond the usual individual and health considerations; it also considers smoking as a societal problem. This contribution illustrates the implementation of this approach, as embodied in France by the Alliance Contre le Tabac denormalization program launched in 2019, through campaigns addressing a diverse range of themes. The latest campaign, carried out in January 2023, demonstrates that smoking also exacerbates the social and economic difficulties of the most disadvantaged members of society. Its presentation illustrates the deployment of such a campaign, the methodology used, the tools mobilized, and the results obtained by carrying out a post-test.

Cet article présente l'approche dite de dénormalisation, qui s'est progressivement imposée dans le champ de la lutte contre le tabac. Cette démarche regroupe un ensemble varié de pratiques et entend renouveler les méthodes de la lutte contre le tabac en élargissant sa portée au-delà des considérations individuelles et sanitaires habituelles ; elle envisage le tabagisme en tant que problématique sociétale. Cette contribution illustre la mise en œuvre de cette approche, incarnée en France par les campagnes de dénormalisation de l'Alliance Contre le Tabac depuis 2019. La dernière campagne réalisée en janvier 2023 démontre que le tabagisme, au-delà de son impact sanitaire, aggrave aussi les difficultés financières quotidiennes des personnes les plus modestes. La présentation de ce dispositif permet d'illustrer le déploiement de ce type de campagne, la méthodologie utilisée, les outils mobilisés et les résultats obtenus, grâce à la réalisation d'un post-test.

Dénormalisation du tabac et de son industrie par la société civile : mise en œuvre et évaluation de la campagne « Pouvoir de vivre ¼ par l'ACT ­ Alliance contre le tabac.

This article examines the "denormalization" approach, which has gradually gained ground in the field of tobacco control. This process encompasses a wide range of practices and aims to renew tobacco control by extending its scope beyond the usual individual and health considerations; it also considers smoking as a societal problem. This contribution illustrates the implementation of this approach, as embodied in France by the Alliance Contre le Tabac denormalization program launched in 2019, through campaigns addressing a diverse range of themes. The latest campaign, carried out in January 2023, demonstrates that smoking also exacerbates the social and economic difficulties of the most disadvantaged members of society. Its presentation illustrates the deployment of such a campaign, the methodology used, the tools mobilized, and the results obtained by carrying out a post-test.