The response to the COVID 19 pandemic : the contribution of the meso level of primary care in France.

Hector Falcoff

Keywords: COVID 19, meso level, primary care organization

Introduction:
The Professional Territorial Health Communities (PTHC) were established by French law in 2016. These are associations, created on the initiative of health professionals (HP). A PTHCs is the meso level of the organization of primary care, targeting a territory and its population, complementary to the micro level which targets the practice and its patient list. The PTHCs have missions concerning access to care, requests for unscheduled care, coordination, preventive care, quality improvement, and HP support. PTHCs are financed by the National Health Insurance. At the beginning of 2022 there were 690 PTHCs, at different stages of development.

Method:
My presentation will focus on the experience of one of the oldest PTHC, which existed as a pilot experience since 2011, and which is located in an area of Paris (13th and 14th districts, 320,000 inhabitants).

Results:
Here are some of the initiatives developed during the pandemic by the PTHC, which involved more than 500 HP on a voluntary basis :
- recovery and distribution of protective equipment ;
- webinars and newsletters to synthesize government recommendations ;
- telephone platform 8/20 & 7/7, to inform and guide HP ;
- development of local protocols (exemple : Home management of patients with moderate hypoxia) ;
- response to palliative care emergencies (night and weekends) in the area's nursing homes ;
- consultations in hotels where homeless persons were confined during the lock-down ;
- PCR screening, education of infected subjects and their families, contact tracing, screening at home if necessary (elderly, large families...) ;
- organization of a vaccination center in the Town Hall of the 13th district, and mobile teams to outreach people who could not come to the center.

Conclusions:
In areas where PTHC are well developed, the pandemic provides a good illustration of their ability to deal with major public health crisis.

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