P. Lombrail

Université Sorbonne Paris Nord / Sorbonne Paris Nord University, Santé Publique, Faculty Member

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a Moroccan

perception among health care workers:

[Towards equity in migrant's health ?]

La Revue du praticien, 2019

Migrant populations, due to their condition of migrants, are exposed to structural vulnerability ... more Migrant populations, due to their condition of migrants, are exposed to structural vulnerability factors, which influence their health status. Globally, evidences on the negative impact of these structural factors on migrants' health are increasing. We hereby describe these structural factors, which exert their influence at health system's macro-, meso- and micro-levels. We then propose some solutions in order to mitigate the negative effects of these factors on migrants' health. We highlight some key attributes which would qualify an organization as "health literacy sensitive", which would constitute a step towards migrant's health equity.

Beds Simulator 1.0: a software for the modelisation of the number of beds required for a hospital department

Studies in health technology and informatics, 2003

The determination of the number of beds needed for a hospital department is a complex problem tha... more The determination of the number of beds needed for a hospital department is a complex problem that try to take into account efficiency, forecasting of needs, appropriateness of stays. Health authority used methods based on ratios that do not take into account local specificities and use rather to support an economic decision. On the other side, the models developed are too specific to be applied to all type of hospital department. Moreover, all the solutions depend on the LoS (Length of Stay). We have developed a non parametric method to solve this problem. This modelisation was successfully tested in teaching and non teaching hospitals, for an Intensive Care Unit, two Internal Medicine and a surgical departments. A software easy to use was developed, working on Windows available on our website www.sante.univ-nantes.fr/med/stat/.

Public Health from a Different Perspective

The adoption of a national healthcare strategy coupled to a national research strategy, with a cl... more The adoption of a national healthcare strategy coupled to a national research strategy, with a clear commitment to reducing inequality in healthcare, constitutes the stand-out event of the last few years in healthcare policy in our country. The first measures taken are starting to turn this ambition into a legal reality. However, resistance to change is strong, and driven by powerful lobbies which make it difficult to introduce measures to promote and protect health. They also cling to the heritage of a past which obscures the future when it prevents the redefining of the missions of various healthcare professionals, such as their remuneration in the non-hospital setting, or, more generally, overcoming financing methods sequestered within the healthcare system between health and social. However, inequality in healthcare is deepening and only a truly intersectoral mobilisation is likely to reverse this trend. At the highest levels of the State and areas of life, by strengthening citi...

Nursing Role for Medication Stewardship Within Long-Term Care Facilities

Nursing Science Quarterly, 2019

Elderly residents in long-term care facilities (LTCFs) constitute a population noted to have a la... more Elderly residents in long-term care facilities (LTCFs) constitute a population noted to have a large number of medications prescribed and administered. The aim of this article is to explore the nursing role for medication management, with an emphasis on antimicrobial stewardship, guided by disciplinary knowledge of King’s theory of goal attainment and skill-based medication knowledge. The outcome is a nursing workforce truly engaged in working with interdisciplinary colleagues and focusing on care planning that includes medication management to improve the health status of residents in long-term care facilities.

Panorama des politiques publiques françaises de promotion de l’activité physique bénéfique pour la santé

Santé Publique, 2016

Introduction : L’inactivite physique est largement reconnue comme etant un facteur de risque de m... more Introduction : L’inactivite physique est largement reconnue comme etant un facteur de risque de maladies non transmissibles et de mortalite evitable. Pourtant son taux progresse en France comme en Europe. De multiples determinants influencent l’adoption d’un mode de vie physiquement actif et parmi eux, l’elaboration, la mise en place et la coordination de politiques publiques. La Societe Francaise de Sante Publique a entrepris un projet d’analyse des politiques publiques nationales de promotion de l’activite physique en France. Cet article presente une partie des resultats de ce projet en dressant le panorama de ces politiques ainsi que de leurs acteurs gouvernementaux. Methodes : Cette analyse s’appuie sur l’utilisation du questionnaire HEPA-PAT (Health Enhancing Physical Activity-Policy Audit Tool), dont l’objectif est d’offrir une vue d’ensemble des politiques publiques nationales de promotion de l’activite physique d’un pays, et d’identifier les leviers utilises ou a renforcer pour promouvoir une activite physique benefique pour la sante. Ces premiers resultats sont issus de la realisation de 15 entretiens, d’une recherche documentaire et d’un seminaire de validation. Resultats : L’analyse des resultats montre qu’il n’existe pas aujourd’hui en France une politique publique globale de promotion de l’activite physique a visee de sante, mais que les politiques sont impulsees par les Ministeres en charge de la Sante, des Sports et du Developpement Durable, et relayee par plusieurs autres ministeres. Discussion : Si des strategies multiples sont utilisees pour promouvoir l’activite physique, celles-ci ne couvrent cependant pas l’ensemble des secteurs. Cette configuration interroge egalement l’harmonisation de ces politiques publiques nationales et l’existence de mecanismes de coordination intersectorielle.

[Health literacy and patient education interventions: a review]

Sante publique (Vandoeuvre-les-Nancy, France)

Low health literacy (HL) is an obstacle to therapeutic patient education (TPE), especially for pe... more Low health literacy (HL) is an obstacle to therapeutic patient education (TPE), especially for people in a vulnerable situation, who are also at greater risk of chronic illnesses and their complications. It therefore seems essential to rethink TPE programmes in order to ensure greater equity based on analysis of the characteristics of HL interventions and their possible relationships with TPE. A scoping review of the literature was performed from November 2014 to January 2016 using the following search engines: MEDLINE/PubMed, EMBASE, PsycINFO, ERIC, OpenGrey, SUDOC, thèses.fr and BDSP and the following search terms: ?health literacy?, ?Littératie en santé?, ?literacy?, ?Littératie?, ?numeracy?, ?numératie?, ?compétence en santé? combined with the keywords: ?programme?, ?program?, ?intervention?, ?méthode?, ?method?, ?technique?, ?outil?, ?tool?. After selecting forty out of 206 studies, interventions were classified into two main types of specific interventions to promote comprehen...

[Overview of French public policies promoting health-enhancing physical activity]

Sante publique (Vandoeuvre-les-Nancy, France), Jun 8, 2016

Although multiple strategies are used to promote physical activity, they do not cover all sectors... more Although multiple strategies are used to promote physical activity, they do not cover all sectors. This configuration also raises the question of the harmonization of these national public policies and the existence of intersectoral coordination mechanisms.<np pagenum="026"/> </ce:para>.

Les enjeux de la qualité dans la réforme hospitalière

Gestions Hospitalieres, 1996

Qu'appelle-t-on « performances hospitalieres » ?

Dossiers Solidarite Et Sante, 2001

Orientation à la sortie de l'hôpital et durée de séjour hospitalier des personnes âgées admises par les urgences

Revue D Epidemiologie Et De Sante Publique, 1995

A prospective study was organized in two teaching hospitals in Paris, including 426 elderly patie... more A prospective study was organized in two teaching hospitals in Paris, including 426 elderly patients aged 75 and more, who had been hospitalized through the medical emergency department. The goal of the study was to assess the influence of difficulties of orientation at discharge on the length of stay, independently of other risk factors. The mean length of stay was 18.3 +/- 15.4 days. Orientation at discharge toward a social or a nursing care institution was associated with a 12 days longer mean length of stay than a home discharge. A longer length of stay was also associated with: a strictly social problem at admission, the diagnoses of dementia, confusion, social problem, fall or general health impairment, a short or long-term fatal prognosis, a poor mental status, refusal of home discharge as expressed by the referent person. Multivariate analysis showed that discharge toward a social or a nursing care institution was the first explanatory factor, explaining 12% of variance. These results suggest that the hospital discharge management has a major influence on the elderly length of hospital stay. Therefore, an interdisciplinary care management, including social and geriatric evaluation as soon as the patient is admitted at the emergency department, should be evaluated, in order to avoid problems of orientation that may occur at discharge.

Indicateurs de suivi de l'évolution des inégalités sociales de santé dans les systèmes d'information en santé

Ce rapport répond à deux saisines de la DGS et la DREES, portant d’une part sur la pertinence et ... more Ce rapport répond à deux saisines de la DGS et la DREES, portant d’une part sur la pertinence et les possibilités de prise en compte des caractéristiques sociales dans les indicateurs transversaux et spécifiques associés aux objectifs de la loi de santé publique, et sur la hiérarchisation des indices écologiques de défavorisation sociale ; d’autre part sur la proposition d’indicateurs permettant « d’assurer le suivi des inégalités de santé dans le domaine du cancer, de ses facteurs de risque et de ses conséquences, notamment en termes de mortalité ». Le HCSP analyse les éléments disponibles pour rendre compte de l’évolution des inégalités sociales de santé et propose des indicateurs à insérer dans les systèmes d’information en santé, ainsi que des évolutions à apporter dans ces systèmes d’information, de façon à prendre en compte ces inégalités sociales de santé dans les différents types d’usages des données de santé : systèmes de recueil de données en routine (mortalité, morbidité,...

B4-6 Inégalités sociales et accès aux soins : différenciation des besoins de soins préventifs des consultants de l’hôpital public

Revue d'Épidémiologie et de Santé Publique, 2004

[A national health strategy is not limited to the optimization of individual care]

Santé publique (Vandoeuvre-lès-Nancy, France)

[What is the future of the law of public health?]

Santé publique (Vandoeuvre-lès-Nancy, France)

[Appropriateness of prescriptions of intravenous paracetamol at Nantes Teaching Hospital: a follow-up indicator for quality improvement]

Presse médicale (Paris, France : 1983), 2010

[Development of a tool for the identification of socially vulnerable hospital patients]

Presse médicale (Paris, France : 1983), Jan 19, 2004

To develop and assess the metrological properties of a simple to use tool to identify socially vu... more To develop and assess the metrological properties of a simple to use tool to identify socially vulnerable outpatients. A multidisciplinary group of professionals selected five characteristics identifying social vulnerability, integrated in a self-reported questionnaire, from which 5 criteria identify the socially vulnerable outpatients consulting the hospital. The metrological performance of the tool was assessed on a sample of randomly selected outpatients admitted to the emergency department and the results referred to the independent assessment of two social workers. The sensitivity and specificity of the tool were determined and ROC curves drawn. 222 patients were included, aged from 15 to 93 Years (mean: 53 Years), 59% of whom were men. 78% filled out the questionnaire on their own, while 22% required help, usually for physical or material reasons and 87% answered the five questions without any difficulty. The kappa coefficient of agreement between the two social workers was es...

L’information du patient à l’hôpital, un partage implicite des rôles entre professionnels ?

La Presse Médicale, 2004

ABSTRACT

Pertinence des prescriptions médicamenteuses, expérience française

Thérapie, 2010

Appropriateness of care, applied to medical prescription, is a fast-growing professional practice... more Appropriateness of care, applied to medical prescription, is a fast-growing professional practice evaluation method, within a context of control spending and quality improvement. A literature review related to the last ten years found 38 publications, including 19 original studies. Results showed that only few studies were published, and that methodologies were not standardized. Development of pedagogical data tools is essential to increase doctor&amp;amp;amp;amp;amp;amp;#39;s awareness. Analysis of causes of inappropriateness has to be conducted, in order to plan improvement actions. A second evaluation is necessary to assess the impact of appropriateness review on professional practices.

Pratiques de prise en charge du cancer du côlon en Loire-Atlantique en 2000

Revue d'Épidémiologie et de Santé Publique, 2008

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