Health mediation: an intervention mode for improving emergency department care and support for patients living in precarious conditions

BMC Health Services Research

Research

Aurore Lamouroux¹  Michel Rotily²  Pascal Auquier³  Themistoklis Apostolidis⁴  Riwan Naït Salem⁴  Sophie Odena⁵  Célia Chischportich⁶  Nicolas Persico⁷ 

[1] Centre de Santé Universitaire - Espace Santé Aygalades - Assistance Publique Hopitaux de Marseille, Marseille, France;Centre de Santé Universitaire - Espace Santé Aygalades - Assistance Publique Hopitaux de Marseille, Marseille, France;Centre d’Etudes et de Recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université, Marseille, France;Centre d’Etudes et de Recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université, Marseille, France;Laboratoire de Psychologie Sociale (LPS), Aix Marseille Université, Aix-en-Provence, France;Laboratoire d’Economie et de Sociologie du Travail (LEST-UMR 7317), Aix Marseille Université, Aix-en-Provence, France;SCOP Regards Santé, Marseille, France;Service d’Accueil des Urgences Adultes, Hopital Nord, Assistance Publique Hopitaux de Marseille, Marseille, France;

关键词: Health mediation;    Emergency department;    Frequent health service users;    Precariousness;    Vulnerable populations;    Case management;   

DOI  :  10.1186/s12913-023-09522-4

 received in 2022-03-25, accepted in 2023-05-09,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundSevere overcrowding of emergency departments (EDs) impacts the quality of healthcare. One factor of this overcrowding is precariousness, but it has rarely been considered a key factor in designing interventions to improve ED care. Health mediation (HM) aims to facilitate access to rights, prevention, and care for the most vulnerable persons and to raise awareness among healthcare providers about obstacles in accessing healthcare. We here present the results of an ancillary qualitative study to explore the prospects regarding a health mediation intervention implemented in EDs for deprived persons who are frequent ED users, from professionals’ and patients’ perspectives.MethodsDesign, data collection, and data analysis were done according to a psychosocial approach, based on thematic content analysis and semi-structured interviews of 16 frequent ED users and deprived patients exposed to HM and of 14 professionals in 4 EDs of South-eastern France.ResultsAll patients reported multifactorial distress. Most of them expressed experiencing isolation and powerlessness, and lacking personal resources to cope with healthcare. They mentioned the use of ED as a way of quickly meeting a professional to respond to their suffering, and recognized the trustworthy alliance with health mediators (HMrs) as a means to put them back in a healthcare pathway. The presence of HMrs in EDs was appreciated by ED professionals because HMrs responded to requests they were not able to access and were perceived as an efficient support for caring for deprived persons in emergency contexts.ConclusionsOur results are in favour of health mediation in EDs as a promising solution, requested by patients and ED professionals, to cope with frequent ED users and deprived patients. Our results could also be used to adapt other strategies for the most vulnerable populations to reduce the frequency of ED readmissions. At the interface of the patients’ health experience and the medico-social sector, HM could complete the immediate responses to medical needs given in EDs and contribute in alleviating the social inequalities of health.

【 授权许可】

CC BY   
© The Author(s) 2023