The development of a quality approach within multi-professional health centres (MSPs) is key to improving the quality of care. This requires operational and accessible tools, in particular indicators that enable MSPs to self-assess over time. In 2022, a qualitative study involving semi-structured group interviews in seven MSPs, followed by a consensus method, led to the development of MSProgress, a prototype tool consisting of quantitative care indicators that can be retrieved from the Health Insurance databases. Then, in 2023, a second study made it possible to adjust and consolidate the tool before it could be deployed and evaluated on a larger scale.The objective of this study is to examine how the MSProgress tool is being adopted, to describe the team's indicator selection process and to understand the tool's effects on the structuring of the quality approach in MSPs.A mixed study was conducted among 32 MSPs in the XXX region, 12 of which participated in the development of the tool and 20 of which did not. The qualitative part was based on semi-structured group interviews with professionals with analysis by triangulation using a general inductive method by thematization. The quantitative part used anonymous individual questionnaires distributed to MSPs professionals.There are multiple approaches to quality: from lack of knowledge to routine integration, the trajectories of appropriation vary according to acculturation to indicators, the uses of shared information systems, internal logic and territorial contexts. The mechanisms of decision-making are complexe: the central role of driving duos (coordinators and medical leaders), the ambivalence of collective bodies, the differentiated weight of voices according to profession, and the importance of informal negotiations.MSProgress does not create cooperation but makes it visible, sometimes reinforcing it, sometimes putting it to the test. Far from being a uniform model, the appropriation of the tool appears to be a local factory of quality, situated, traversed by implicit hierarchies and ongoing negotiations.The results of this study have highlighted the processes of indicator selection by teams and the organisational dynamics underlying these choices. Support for teams appears essential to reduce differences in maturity in relation to indicators.

The development of quality procedures within multi-professional health centers (MSPs) is key to improving the quality of care. It requires operational and accessible tools, particularly indicators that enable structures to self-assess over time. In 2022, a qualitative study using semi-structured group interviews in seven MSPs, followed by a consensus method, led to the development of MSProgress, a prototype tool consisting of quantitative indicators that can be queried in the Health Insurance databases.The objective of this pilot study is to test the prototype tool with MSPs in order to gather collective and individual opinions on the form, understanding, and use of this tool.A mixed study was conducted among 11 MSPs in the XXX region, six of which participated in the development of the tool and five of which did not. The sample was constituted by theoretical maximum variation. The qualitative part was based on semi-structured group interviews with professionals from these MSPs, with triangulation analysis using a general inductive method by thematization. The quantitative part used individual anonymous questionnaires distributed to professionals from these MSPs.The teams surveyed were enthusiastic about the form and use of the tool, pointing in particular to the value of having access to new data and being able to self-assess. The tool was found to be understandable, easy to use as a team, and relevant for monitoring patient care by 95%, 84%, and 88% of professionals, respectively. Comparing the results with the average for other MSPs in the region and tracking changes in indicators over time was considered interesting by 84% and 98% of them, respectively.One of the strengths of this work lies in the mixed method used to gather the opinions of MSP professionals at both the collective and individual levels, both from those who participated in the development of the tool and those who did not contribute to it. One of the limitations of the tool remains its restriction to the patient base of the treating physician.The feedback provided enabled the prototype to be improved before its deployment and evaluation at the regional level.

Healthcare professionals are particularly exposed to stress and burnout. They are among the professions with one of the highest suicide rates in France. Since the COVID 19 epidemic, these professionals have also been suffering from a loss of meaning in their activities, due in part to their working conditions (understaffing, unsuitable workloads and care rhythms, physical/verbal violence, red tape, etc.).To raise caregivers' awareness, change their outlook and take care of their mental health, this study looked into the benefits of setting up a soothing room at the heart of the care structure, for use by caregivers. This would be a space dedicated to caregivers, using the Snoezelen universe to offer a cocoon of safety, and tools validated by neuroscience (such as mindfulness meditation, breathing exercises, micro-naps and yoga). This space would be set up by experts in co-development as well as preventive and integrative medicine.Through a mainly qualitative study, we interviewed caregivers (10 individualized semi-directive interviews) working in a non-programmed care center (CSNP) in the Pays de Gex (01). We sought to understand their perception of work and mental health, as well as non-medicinal approaches to health. Finally, we were interested in their feelings about the implementation and feasibility of a new-generation soothing room (MERCY Space type).These interviews enabled us to gain a better understanding of the issues, false beliefs and difficulties surrounding the mental health of healthcare professionals. Indeed, there is still a great deal of prejudice, ignorance and fear surrounding the subject, not only among caregivers but also among managers of healthcare facilities.Thanks to this study, we were able to draw up mental health recommendations on three levels (caregivers, managers, image of mental health). One of these recommendations is to set up a MERCY Space-type soothing room in healthcare establishments.In view of the obstacles (time for caregivers, budget for managers), it is essential to see these spaces as a gateway to a global, virtuous and humanistic approach to mental health for caregivers.

Primary care faces increasing pressure due to population ageing, multimorbidity and workforce shortages. Nurses in general practice (GP) are increasingly involved in strengthening interprofessional collaboration within multidisciplinary teams. However, the indicators that best describe interprofessional collaboration in GP remain unclear.To identify indicators that can assess interprofessional collaboration in general practice.Indicators were identified through a systematic review of Cochrane Library, PubMed (Medline) and Embase, complemented by expert consultation (n = 8) via co-creation workshops. Following project team review, indicators were categorised using the SEIPS work-system framework (persons, tasks, tools, organisation, internal and external environment).Sixty-seven studies met the inclusion criteria, yielding 673 indicators related to team functioning. Experts proposed an additional 42 indicators. Most literature-derived indicators fell within the SEIPS domains of organisation (n = 326) and persons (n = 246). Core themes included shared vision, clarity of roles, communication quality, leadership, team culture and structured decision-making. Expert consultation added indicators related to task expansion, mental well-being, efficiency, onboarding processes, and external collaboration. Three clusters emerged as central to interprofessional collaboration in GP: (1) shared vision on the nurse’s role, (2) breadth and depth of task reallocation, and (3) frequency and structure of multidisciplinary meetings.The identification process revealed a substantial heterogeneity in the indicators describing interprofessional collaboration, reflecting considerable variation in definitions and measurement approaches across studies. The limited number of GP-specific indicators highlights an evidence gap on team-level effects of nurses, necessitating a broader primary-care perspective. The SEIPS model proved the most suitable framework, capturing the complexity of multidisciplinary team functioning more comprehensively than alternative models.This study provides a comprehensive, evidence-informed set of indicators for assessing interprofessional collaboration in GP. For general practices, these indicators offer practical guidance for identifying and strengthening organisational and relational factors that support effective teamwork. For research, they form an essential foundation for developing an assessment instrument to systematically evaluate interprofessional collaboration. Further research is needed to deepen understanding of collaborative processes and to inform interventions that promote sustainable, high-quality teamwork in GP.

With both the population and the healthcare workforce ageing, and hospital care costs rising, strengthening primary care has become essential. Delegating selected clinical tasks to nurses is increasingly considered to reduce GP workload, but this requires structured education and competency-based training to ensure safe and effective practice.A three-year nationwide project Support for education in primary care for general practitioners, paediatric general practitioners, and support for regional accessibility of healthcare (Project registration number: CZ.03.02.02/00/24_060/0005126), co-financed by the European Social Fund through the Employment Plus Operational Programme and the state budget of the Czech Republic, was launched by the Institute for Postgraduate Medical Education in 2025. The project includes several key activities focusing on 1. Regional GP education, 2. Competency-based education, methodology of specialty training and improvement of the assessment of education, providing education for trainers in GP, 3. Education for nurses in GP, implemented initially as a pilot program. The presented work focuses on key activity 3.The courses aim to establish a foundation for GP nurses’ educational activities, assess current learning needs, and promote professional development. They also foster teamwork, improve care coordination, and strengthen interprofessional communication within primary care teams. Additionally, the courses support the development of professional identity and enable discussion regarding the future expansion of nurses’ competencies.To what extent is the education of GP nurses a fundamental prerequisite for strengthening their role in primary care?                                                                                                                      It equips nurses with specific skills that serve as the basis for assuming expanded responsibilities and improving patient care delivery, and deserves to be recognized.Implementing nationwide GP nurses’ education requires a coordinated, well-resourced effort.This EU-supported project, led by Institute for Postgraduate Health Education, represents a significant methodological advancement and provides a sustainable framework for future national and regional educational initiatives targeting nurses in general practice.

An effective healthcare system relies on structured primary care. In France, the general practitioner plays a central role in coordinating care, particularly in prescribing interventions by paramedical professionals. The initiation of care is contingent on the general practitioner writing a prescription, which often serves as the sole medium of interprofessional communication at this stage.This research explores the challenges and issues of interprofessional communication via medical prescription between general practitioners and health professionals in the context of ambulatory care in the french healthcare system.This is a qualitative study using grounded theory, based on focus group interviews conducted with allied-health professionals practicing one of the following three professions in primary care : physiotherapists, speech therapists, or nurses.Interprofessional communication, which is crucial to patient care, is often reduced to medical prescription. Allied-health professionals report frequent prescribing errors, a lack of feedback from general practitioners on their assessments, and under-use of digital communication tools. They express a desire for direct exchanges.Communication through prescribing is limited by a nomenclature governing the acts performed by the various health professionals. Thus, a dual use of the prescription is observed : as a tool for transmitting medical information and as an administrative and financial document. This original communication is part of a constantly evolving ambulatory system. Exchanges are mainly unilateral, from the GP to the Allied-health professionals. An implicit hierarchy between them hinders dialogue and collaboration. However, allied-health professionals recognize the general practitioner as an essential care coordinator. Mutual trust is fundamental to improving communication and optimizing patient care.Interprofessional communication between general practitioners and allied health professionals is complex. It reflects both the organization of the various professional groups and the constraints on the healthcare system. However, exchanges cannot be reduced to medical prescriptions. Direct, two-way communication is required to improve patient care.

Medical confidentiality in home-based end-of-life care raises major ethical, relational, and organizational challenges for primary care clinicians. The home setting, the frequent presence of relatives, the involvement of multiple professionals, and the emotional intensity of this period can weaken usual confidentiality boundaries. Despite its centrality in the doctor–patient relationship, few studies explore how general practitioners and home-based palliative care teams experience and manage these dilemmas in practice.To explore how healthcare professionals understand, protect, and negotiate medical confidentiality in home-based end-of-life situations; to identify ethical tensions and practical barriers; and to highlight potential levers for safer, person-centred communication.A qualitative study using grounded theory methodology was conducted. Semi-structured interviews were carried out with general practitioners, home-hospitalization physicians, and palliative care professionals involved in home-based end-of-life care. Data were analysed through open, axial, and selective coding with constant comparison until theoretical saturation. A double-coding process strengthened internal validity. All data were fully anonymized.Eight categories emerged. (1) Identifying legitimate interlocutors: uncertainty often exists about who may receive information. (2) Protecting vulnerable patients: “reverse confidentiality,” where relatives request that information be withheld, was frequently reported. (3) Coordinating without breaches: unclear definitions of the “care team” hinder secure information-sharing. (4) Choosing communication tools: paper is seen as simple but exposed; digital tools offer security but remain heterogeneous and sometimes impractical. (5) Supporting caregivers: their involvement is essential yet may destabilize confidentiality. (6) Managing emergencies: time pressure can lead to unintentional breaches. (7) Balancing family expectations: clinicians negotiate between legal obligations and maintaining relational alliance. (8) Maintaining trust: confidentiality is viewed as key to safe end-of-life care.Confidentiality at home in end-of-life care is a dynamic negotiation shaped by relational and organizational factors. The findings underline the need for clearer shared rules, secure tools, and structured ethical reflection within primary care teams.Strengthening confidentiality in home-based end-of-life care requires clarifying team boundaries, improving shared communication tools, supporting caregivers, and reinforcing ethical training. These levers help preserve trust—an essential thread in the final moments of care.