3 questions to… Cécile Fournier, on the occasion of the publication of Issues in Health Economics (232), April 2018: "Doctor-Nurse Cooperation Through ASALEE (Team Health Project in Private Practice): A Space where Primary Care Practices are being transformed", written with Isabelle Bourgeois and Michel Naiditch.
In 2004, in Poitou-Charentes, some doctors wanted to test the idea that a nurse, working in their workplace, could contribute to improving the quality of care for patients, giving them time to express their needs and be assisted in their lives with a chronic disease or risk factor. The ASALEE association, created after a first year of experimentation led by the Regional Union of Private Medical Practitioners (Union régionale des médecins libéraux), obtained the support of the public authorities to develop this project first at departmental level, then in four regions and finally at national level.
Nurses have gradually built their activity, focusing on prevention, screening and therapeutic education. "Delegation of tasks" is carried out within the framework of protocols validated by the French National Authority for Health (Haute Autorité de santé) around four pathologies: diabetes, cardiovascular risk, chronic obstructive pulmonary disease and cognitive disorders. As the project developed, a greater structuring was observed, based on what was invented locally to facilitate work between patients, nurses and doctors: training and supervision of nurses, regular meetings between nurses in the same sector, paid consultation time between doctor and nurse, information system to monitor the activity, etc.
With their doctor and the ASALEE nurse, patients find a space where they can learn and be supported in the management of their daily health. The practices of the nurse and the doctor are built in the interaction between them and with each patient. Thanks to this pair working, some doctors and nurses are considering a new arrangement of their respective tasks. They say that this pair working enables them to better organize screening, therapeutic education and follow-up of their patients, and to invent personalized responses to needs that have not yet been covered: for example, to support patients in smoking cessation or towards resuming physical activity. This shows a twofold shift in health care supply: from prescriptive to proactive educational health care supply, focusing not only on illness but also on health; and from individual care practice to multi-professional teamwork.
This Issue in Health Economics is the first in a series about the ASALEE project. The next publications will first present a typology of cooperation based on a declaratory survey of doctors and nurses, followed by evaluations of the impact of the project on doctors' activities, as well as on patients’ follow-up and health care pathways.
On the qualitative level, we will deepen the analysis of the work that underlies the development of cooperative practices physician-nurse-patient, as well as the study of advanced nursing practices that are being tested in the ASALEE project.
Interview by Anna Marek