Projet Approche Patient Partenaire de Soins (APPS) - Projekts Ansatz der Patienten-Partner-Betreuung

Conference given outside the academic context (2022)

Notre projet a permis d’observer une volonté affichée d’évoluer vers davantage d’engagement du patient dans la relation de soin et dans les structures de soins de santé. Le développement attendu passera ... [more ▼]

Notre projet a permis d’observer une volonté affichée d’évoluer vers davantage d’engagement du patient dans la relation de soin et dans les structures de soins de santé. Le développement attendu passera par une approche systémique de l’engagement tant sur des aspects micro (de la relation de soin) méso (dans la coordination des structures de soins) et macro (avec l’engagement des politiques de santé). Le développement doit s’appuyer sur les initiatives existantes : en ce sens le projet Interreg est une belle façon de promouvoir les échanges de bonnes pratiques au service de cet engagement du patient. [less ▲]

Inequality of educational opportunity differentially impacts women’s and men’s later-life cognitive performance

Scientific Conference (2021, June)

Find the published paper here: https://doi.org/10.1016/j.ssmph.2021.100837

Rewealthization in twenty-first century Western countries: the defining trend of the socioeconomic squeeze of the middle class

in Journal of Chinese Sociology (2021), 8

The wealth-to-income ratio (WIR) in many Western countries, particularly in Europe and North America, increased by a factor of two in the last three decades. This represents a defining empirical trend: a ... [more ▼]

The wealth-to-income ratio (WIR) in many Western countries, particularly in Europe and North America, increased by a factor of two in the last three decades. This represents a defining empirical trend: a rewealthization (from the French repatrimonialisation)—or the comeback of (inherited) wealth primacy since the mid-1990s. For the sociology of social stratification, “occupational classes” based on jobs worked must now be understood within a context of wealth-based domination. This paper first illustrates important empirical features of an era of rising WIR. We then outline the theory of rewealthization as a major factor of class transformations in relation to regimes stabilized in the post-WWII industrial area. Compared to the period where wealth became secondary to education and earnings for middle-class lifestyles, rewealthization steepens society's vertical structure; the "olive-shaped" Western society is replaced by a new one where wealth "abundance" at the top masks social reproduction and frustrations below. [less ▲]

Socioeconomic and behavioural factors associated with access to and use of Personal Health Records

in BMC Medical Informatics and Decision Making (2021), 21

Background: Access to and use of digital technology are more common among people of higher socioeconomic status. These differences might be due to lack of interest, not having physical access or having ... [more ▼]

Background: Access to and use of digital technology are more common among people of higher socioeconomic status. These differences might be due to lack of interest, not having physical access or having lower intentions to use this technology. By integrating the digital divide approach and the User Acceptance of Information Technology (UTAUT) model, this study aims to further our understanding of socioeconomic factors and the mechanisms linked to different stages in the use of Personal Health Records (PHR): desire, intentions and physical access to PHR. Methods: A cross-sectional online and in-person survey was undertaken in the areas of Lorraine (France), Luxembourg, Rhineland-Palatinate and Saarland (Germany), and Wallonia (Belgium). Exploratory factor analysis was performed to group items derived from the UTAUT model. We applied linear and logistic regressions controlling for country-level heterogeneity, health and demographic factors. Results: A total of 829 individuals aged over 18 completed the questionnaire. Socioeconomic inequalities were present in the access to and use of PHR. Education and income played a significant role in individuals' desire to access their PHR. Being older than 65 years, and migrant, were negatively associated with desire to access PHR. An income gradient was found in having a physical access to PHR, while for the subgroup of respondents who expressed desire to have access, higher educational level was positively associated with intentions to regularly use PHR. In fully adjusted model testing the contribution of UTAUT-derived factors, individuals who perceived PHRs to be useful and had the necessary digital skills were more inclined to use their PHR regularly. Social influence, support and lack of anxiety in using technology were strong predictors of regular PHR use. Conclusion: The findings highlight the importance of considering all stages in PHR use: desire to access, physical access and intention to regularly use PHRs, while paying special attention to migrants and people with lower socioeconomic backgrounds who may feel financial constraints and are not able to exploit the potential of PHRs. As PHR use is expected to come with health benefits, facilitating access and regular use for those less inclined could reduce health inequalities and advance health equity. [less ▲]

Cross-border mobility in European countries: associations between cross-border worker status and health outcomes

in BMC Public Health (2021), 21

Mobility of workers living in one country and working in a different country has increased in the European Union. Exposed to commuting factors, cross-border workers (CBWs) constitute a potential high-risk ... [more ▼]

Mobility of workers living in one country and working in a different country has increased in the European Union. Exposed to commuting factors, cross-border workers (CBWs) constitute a potential high-risk population. But the relationships between health and commuting abroad are under-documented. Our aims were to: (1) measure the prevalence of the perceived health status and the physical health outcomes (activity limitation, chronic diseases, disability and no leisure activities), (2) analyse their associations with commuting status as well as (3) with income and health index among CBWs. Based on the ‘Enquête Emploi’, the French cross-sectional survey segment of the European Labour Force Survey (EU LFS), the population was composed of 2,546,802 workers. Inclusion criteria for the samples were aged between 20 and 60 years and living in the French cross-border departments of Germany, Belgium, Switzerland and Luxembourg. The Health Index is an additional measure obtained with five health variables. A logistic model was used to estimate the odds ratios of each group of CBWs, taking non-cross border workers (NCBWs) as the reference group, controlling by demographic background and labour status variables. A sample of 22,828 observations (2456 CBWs vs. 20,372 NCBWs) was retained. The CBW status is negatively associated with chronic diseases and disability. A marginal improvement of the health index is correlated with a wage premium for both NCBWs and CBWs. Commuters to Luxembourg have the best health outcomes, whereas commuters to Germany the worst. CBWs are healthier and have more income. Interpretations suggest (1) a healthy cross-border phenomenon steming from a social selection and a positive association between income and the health index is confirmed; (2) the existence of major health disparities among CBWs; and (3) the rejection of the spillover phenomenon assumption for CBWs. The newly founded European Labour Authority (ELA) should take into account health policies as a promising way to support the cross-border mobility within the European Union. [less ▲]

Detecting the ‘Black Hole’ of age-period excess mortality in 25 countries: Age-period-cohort residual analysis

in Bell, Andrew (Ed.) Age, Period, and Cohort Effects (2021)

In a time of worldwide availability of annual age-specific mortality data, we lack basic tools for detecting and graphing, from a comparative perspective, fine-grained deviations from mortality trends. We ... [more ▼]

In a time of worldwide availability of annual age-specific mortality data, we lack basic tools for detecting and graphing, from a comparative perspective, fine-grained deviations from mortality trends. We provide a new age-period-cohort-based methodology, combining information from age-period (AP) and APC-Detrended (APCD) analyses to detect all-cause mortality increases. Plotting the resulting AP coefficients and APCD residuals in equilateral Lexis diagrams, mortality patterns can easily be distinguished as age, period, or cohort trends and fluctuations. We highlight abnormalities as interactions of age and period (‘Black Holes’). We then investigate the ‘Black Holes’ of mortality of young-adult cohorts in the early 1990s in Spain, other southern European countries, and the U.S., in emphasizing their simultaneously occurring mortality crises. Additional analyses with WHO mortality data and epidemiological evidence from other studies show that these mortality increases likely result from lack of treatment and inadequate public health responses to the beginnings of the HIV/AIDS epidemic. We discuss other possible applications of the new method. [less ▲]

Orienter les soins vers le patient partenaire. Un livre blanc pour la Grande Région

Book published by INTERREG APPS (2020)

Les différents chapitres de ce livre proposent une approche holistique pour faire évoluer le système de santé vers le partenariat de soins. Résultat de trois années de recherche et de concertation, le ... [more ▼]

Les différents chapitres de ce livre proposent une approche holistique pour faire évoluer le système de santé vers le partenariat de soins. Résultat de trois années de recherche et de concertation, le Livre Blanc s’appuie sur des recherches documentaires (analyse de la littérature scientifique et de la législation spécifique de chaque pays), des entretiens et des enquêtes auprès de nombreux acteurs, le repérage et l’analyse d’initiatives en GR et la discussion orientée vers le consensus. Par ailleurs, les propositions de recommandations ont été élaborées et discutées lors d’un séminaire interrégional réalisé en décembre 2019. Le Livre Blanc est structuré en 5 parties qui s’adressent chacune à un public ciblé. La première partie situe le contexte dans lequel s’est réalisé le projet et décrit la méthodologie du programme. La seconde partie est consacrée aux aspects réglementaires de l’approche patient partenaire et à leurs conséquences sur les pratiques et les initiatives analysées sur le terrain. Elle est destinée de manière privilégiée aux mandataires politiques. La troisième partie propose une réflexion sur le développement de stratégies de partenariat au niveau des institutions de santé. Elle concerne les gestionnaires des établissements de santé. La quatrième partie vise à amener les professionnels à s’interroger sur ce que le partenariat de soins peut leur apporter dans leurs pratiques de soins. Elle s’adresse, en particulier, aux acteurs en contact direct avec les patients. La cinquième et dernière partie suggère différentes voies possibles de développement de l’APPS dans les domaines de l’enseignement et de la recherche. Toutes ces parties s’adressent bien évidemment au patient, qui est au coeur de l’APPS. Les prises de position proposées par ce Livre Blanc s’appuient sur les données collectées par le consortium de recherche de 2017 à 2020. Dès lors, ce document ne peut être exhaustif et est appelé à évoluer, basé davantage sur une fonction vectrice de normes que de règles. Pour davantage d’information et pour connaitre nos activités et nos publications, rendezvous sur le site web du projet APPS (https://www.patientpartner.org/). [less ▲]

Core Values that Influence the Patient—Healthcare Professional Power Dynamic: Steering Interaction towards Partnership

in International Journal of Environmental Research and Public Health (2020), 7(8458),

Healthcare has long been marked by the authoritative-physician–passive-patient interaction, with patients seeking help and physicians seeking to restore patients back to health. However, lobalisation ... [more ▼]

Healthcare has long been marked by the authoritative-physician–passive-patient interaction, with patients seeking help and physicians seeking to restore patients back to health. However, lobalisation, social movements, and technological advancements are transforming the nature of this relationship. We aim to identify core values that influence the power dynamic betweenpatients and healthcare professionals, and determine how to steer these interactions towards partnership, a more suitable approach to current healthcare needs. Patients with physical chronic diseases (10 men, 18 women) and healthcare professionals (11 men, 12 women) were interviewed, sessions transcribed, and the framework method used to thematically analyse the data. Validation was done through analyst triangulation and member check recheck. Core values identified as influencing the patient-healthcare professional power dynamic include: (A) values that empower patients (acceptance of diagnosis and autonomy); (B) values unique to healthcare professionals (HCPs) (acknowledging patients experiential knowledge and including patients in the therapeutic process); and (C) shared capitals related to their interactions (communication, information sharing and exchange, collaboration, and mutual commitment). These interdependent core values can be considered prerequisites to the implementation of the patient-as-partner approach in healthcare. Partnership would imply a paradigm shift such that stakeholders systematically examine each other’s perspective, motivations, capabilities, and goals, and then adapt their interactions in this accord, for optimal outcome. [less ▲]

Income Inequality and the Strength of the Origins-Health Gradient in 20 European Countries

Scientific Conference (2019, September 12)

Health is determined by socio-economic position not only of the individual, but also by that of their parents. The intergenerational transmission of health via parental socioeconomic status is suggested ... [more ▼]

Health is determined by socio-economic position not only of the individual, but also by that of their parents. The intergenerational transmission of health via parental socioeconomic status is suggested to vary according to contextual factors such as income inequality. Earlier studies with a comparative perspective had a limited number of countries available. This study uses 20 countries at up to five waves from the European Social Survey (2008-2016) and SWIID in order to examine the extent to which income inequality is related to the origins-health gradient. The higher the income inequality of a given country and year, the stronger the origins-health gradient. Contrary to earlier findings, this association can be fully explained by intergenerational transmission of status, i.e. education. Implications of this finding are that health is largely determined by educational attainment and associated health behaviors, giving societal context a less prominent role than earlier studies suggested. [less ▲]

Income and Wealth Above the Median: New Measurements and Results for Europe and the United States

in Decancq, Koen; van Kerm, Philippe (Eds.) What Drives Inequality (2019)

The study of the upper tail of the income and wealth distributions is important to the understanding of economic inequality. By means of the ‘isograph’, a new tool to describe income or wealth ... [more ▼]

The study of the upper tail of the income and wealth distributions is important to the understanding of economic inequality. By means of the ‘isograph’, a new tool to describe income or wealth distributions, the authors compare wealth and income and wealth-to-income ratios in 16 European countries and the United States using data for years 2013/2014 from the Eurozone Household Finance and Consumption Survey and the US Survey on Consumer Finance. Focussing on the top half of the distribution, the authors find that for households in the top income quintile, wealth-to-income ratios generally increase rapidly with income; the association between high wealth and high incomes is highest among the highest percentiles. There is generally a positive relationship between median wealth in the country and the wealth of the top 1%. However, the United States is an outlier where the median wealth is relatively low but the wealth of the top 1% is extremely high. [less ▲]