LAUSR

For more than 10 years in France, multi-professional healthcare centers have been considered as innovative organizations, which offer attractive work conditions for health professionals and help to structure primary care. Their development is strongly supported by public policy (e.g. specific funding methods, a target of 2000 teams by 2022) and is seen as a mean to enhance preventive actions. From a public health perspective, when professionals define their collective project, preventive actions should be chosen according to their relevance (by considering local population needs), effectiveness (based on evidence) and realism (in terms of implementation). Our goal was to make an inventory of existing tools and recommendations but also to propose a framework that considers the actual practicing conditions of French primary care teams. Three methods were used: a bibliographic study, feedback from a consulting firm with a 10 years’ experience in supporting new teams in defining their multi-professional project, and interviews from experts and health professionals. Due to professional training and practice, preventive actions are less familiar to professionals when they are not integrated into individual and curative cares. Indeed, most existing recommendations are designed from a macroscopic point of view, dismissing the particularities of multi-professional private practice. Thus, we could identify 9 categories of factors likely to determine the relevance of a preventive action, including a specific context-population-team setting. Although this is an exploratory work, feedback from professionals confirms the potential positive or negative influence of these items on the implementation of an action. Our framework could be converted into a tool consisting of a list of questions to ask before primary care teams choose a preventive action to implement. Frequent assessments should be carried out and shared in order to develop empirical and reliable knowledge in this field. Despite a strong public policy to develop multi-professional health care centers in France, recommendations about preventive actions insufficiently consider specific conditions of practice. Mixing theoretical and practical perspectives, our framework could help to improve the relevance, effectiveness and realism of preventive actions considering a specific context-population-team setting.