In 1961, White described patterns of access to healthcare in the United States, showing that most health problems were managed in primary care, with fewer patients accessing secondary or tertiary services. Subsequent studies have demonstrated the stability and broad applicability of this ecology of care model. The increasing complexity of health needs, and the demographic evolution of human resources have led to the evolution of care models. Collaborative health practices have been promoted and strengthened.The present study aims to extend this framework in France by incorporating reimbursed care delivered by non-physician professionals, in order to better reflect patients’ contacts with health system.We conducted a nationwide, population-based, cross-sectional study using data from the French National Health Data System (SNDS). The SNDS covers about 99% of the French population and contains longitudinal records of all primary and secondary care reimbursed health expenses. Following White’s medical ecology framework, healthcare use was measured as the number of beneficiaries per 1,000 persons with at least one reimbursement (“contact”) in a given month. All individuals covered by the database in 2018 were included.In 2018, the monthly number of contacts with ambulatory care were 231 per 1,000 persons with ambulatory general practitioners, 77 per 1,000 persons with other ambulatory specialists, 72 per 1,000 persons with dentists and 5 per 1,000 persons with midwives. The monthly numbers of other contacts in primary care were reprensented by: 61 per 1,000 persons with nurses, 56 per 1,000 persons with physiotherapists, 10 per 1,000 persons with speech therapists. The monthly number of hospital contacts per 1,000 persons was 36  with hospital specialists, and 11 for hospitalizations.Non-physician professionals contribute significantly to healthcare use in France. Their inclusion in the ecology of care framework provides a more comprehensive view of patient pathways and highlights the multidisciplinary nature of healthcare delivery. Ongoing analyses stratified by age and sex will provide additional insights on this model.Integrating reimbursed care from non-physician professionals enhances the understanding of healthcare use in France. This expanded ecology of care underscores the importance of interprofessional primary care and offers relevant insights for health policy and planning.

Patients with complex post-COVID issues were referred by their general practitioner to a post-COVID carepath of 6 months in the Nijmegen region within the Netlherlands (2022-2024). The core component was a regionally operating casemanager. This individual: 1) provides recognition and explanation, 2) coordinates and organizes care, and 3) fosters interdisciplinary collaboration within the care network.This study evaluated the long-term impact of post-COVID carepath with the involvement of a casemanager.This mixed-methods study evaluated quantitatively symptomatology, cognition, daily functioning, quality of life, and coping with symptoms at baseline and after 3 and 6 months for 193 patients. After 2 years (n=82 patients), we repeated questionnaires and added questions on post-exertional malaise (PEM), orthostatic intolerance (OI), healthcare utilization, and informal caregiving. We used the systematic and reflexive interviewing and reporting (SRIR) method for collecting, organizing, coding, and analyzing qualitative data. We interviewed 18 patients, 3 casemanagers, and 15 professionals.          Casemanagers referred most often to two or three allied healthcare professionals, most often to occcupational therapy (85%) and physiotherapy (61%). The total time spent on 6 months casemanagement is 321 minutes per patient. Patient satisfaction was high with 8.3 (1-10). After 6 months, symptoms have decreased, functioning in household and social contacts has improved, and the denial, resistance, and sadness regarding the illness have decreased. The 2-year follow-up measurement shows a mixed picture; some symptoms continue to decrease, while others remain stable or worsen. Patients with PEM (66%) and OI (36%) exhibit more severe symptomatology and worsen without care pathway guidance. The integrated thematic analyses of the interviews revealed four overarching domains: 1. Patient navigation and empowerment 2. Coordination and continuity of care within the care path 3. Communication and interprofessional collaboration 4. Core attributes and competencies of post-COVID case managers.Care for patients with PEM and OI requires a different approach than for patients without these conditions.The patient group experiences severe health issues for which long-term recognition, acknowledgment, support, guidance, and treatment are necessary. The case manager relieves the general practitioner, medical specialists, and family by taking charge to ensure that the appropriate care is provided.

In Finland, primary care facilities typically host co-located multidisciplinary health professionals, enabling interprofessional collaboration (IPC) to support coordinated service delivery. More knowledge is needed on physicians’ perspectives on its effectiveness and areas for improvement.This study aimed to explore primary care physicians’ (PCPs) perceptions of current IPC practices and identify opportunities for improvement to advance collaborative care.A qualitative descriptive approach was adopted, involving PCPs from both urban and rural primary health care (PHC) units across all Finnish wellbeing services counties. Data were gathered through a nationwide online survey. Responses to two open-ended questions were analyzed using inductive thematic analysis, guided by conceptual orientations of interprofessional work.A total of 270 PCPs participated. Two overarching themes derived regarding existing practices: (1) Factors sustaining chain-like IPC, marked by structural limitations and conventional role-based practices; and (2) Factors enabling shared knowledge creation, encompassing structural supports such as collaborative environments, model-based approaches, and team structures, alongside attitudes and values promoting communication and joint learning. Development needs highlighted by participants included stronger leadership for collaboration, improved work environments and culture, structured models, and communication strategies.The study identified two distinct orientations of IPC: a traditional model, shaped by structural constraints, and a shared-knowledge model, supported by collaborative environments.Improved IPC requires stronger leadership, supportive work settings, and structured models. Future research should investigate IPC orientations in relation to patient experiences and roles, and interactions with other professionals.

Across Europe, social inequities in health continue to hinder access to care, particularly in socioeconomically deprived neighbourhoods. General practitioners (GPs) frequently encounter patients facing administrative hurdles, fragmented services and low health literacy. Health mediation and social prescribing are increasingly promoted as solutions to bridge medical and social needs and strengthen patient autonomy. However, programme design is often top-down, and little is known about what communities themselves identify as their most important needs. Despite the expansion of health mediation initiatives and additional roles in primary care such as link workers, few studies have explored these needs from the perspective of residents living in deprived neighbourhoods. To address this gap, a qualitative study was implemented in a priority urban neighbourhood.To explore, from a community perspective, the health mediation needs of residents in a French priority urban neighbourhood, with the aim of informing the design of primary care and social prescribing programmes.We conducted a qualitative phenomenological study using semi-structured interviews with adult residents. Purposive sampling ensured diversity in language, social situation and healthcare use. Interviews explored lived experiences of accessing care, perceived obstacles, expectations of health mediation and preferred forms of support. Data were analysed thematically until saturation.Ten interviews were conducted, reflecting a wide range of social and linguistic backgrounds. Participants described significant difficulties with administrative procedures, care navigation and communication with healthcare services. Five community-defined priorities emerged: - simplifying administrative processes through a clear medico-social interface; - supporting navigation and understanding of care pathways; - increasing professionals’ awareness of the impact of social vulnerability on care; - promoting empowerment by valuing patient experience and reducing stigma; - developing accessible health promotion activities, particularly for mental health.These findings highlight the importance of designing mediation and social prescribing programmes grounded in the lived experiences of the populations they serve, rather than solely on professional or institutional perspectives.A community-driven approach is essential to improving access, autonomy and continuity of care in deprived areas. Integrating health mediators sustainably into primary care requires long-term funding and programmes that are shaped directly by residents’ expressed needs.

Statin intolerance, whether real or perceived, is common in primary care practice. These patients face the choice of either discontinuing treatment and thereby increasing their cardiovascular risk, or taking a less effective substitute (fibrates or ezetimibe monotherapy) or a much more expensive alternative (anti-PCSK9 antibodies). Since they anticipate adverse effects when considering resuming statin therapy, rechallenging statin therapy is likely to fail. By contrast, a blinded N-of-1 test approach is likely to circumvent this cognitive bias. An N-of-1 test is a double-blinded multiple crossover clinical trial run in a single patient, in which random allocation determines sequences of active treatment and control periods.Four patients at high cardiovascular risk who had discontinued their statin treatment were offered an N-of-1 test between 2021 and 2024 to compare the tolerability of a statin with either a placebo or an active comparator (ezetimibe or fenofibrate). Placebo was chosen in two patients not taking any lipid-lowering treatment before the test. Each patient gave their consent for the test. The dispensing pharmacist, duly informed, prepared identical capsules containing either the statin or the comparator and randomly assigned treatment sequences in blocks of two. Each test consisted of six 21-day treatment periods alternating simvastatin and placebo, or 28-day treatment periods alternating simvastatin and the active comparator. Patients assessed their tolerance daily using visual analogue scales for muscle pain. At the end of the test, after unblinding, the results were graphed and analysed with the patients.All four patients completed their tests, filling in 88% to 99% of the daily pain scales. After test completion, they all rated their pain as moderate and unrelated to statins, and subsequently resumed statin therapy, which they continue until now. Patients draw immediate benefit from the test.The same approach has been used successfully in the UK in two recent randomised placebo-controlled trials using an N-of-1 approach and designed to assess statin tolerance and nocebo effects.Our experience proves that conducting N-of-1 tests is feasible in primary care teams.

In our primary care team,within the context of social and healthcare interventions in our health area,we have identified a need to improve care for our patients with fibromyalgia syndrome,and therefore we have decided to implement a multidisciplinary educational intervention.Main objetive:To evaluate the impact of a multidisciplinary educational intervention in fibromyalgia patients in a health district on their perception of quality of life and disease control, their symptoms of depression and anxiety, their perception of pain, and their use of healthcare resources. Specific Objectives:-To analyze changes in patients' quality of life before and after the intervention using the FIQ-R questionnaire. -To evaluate the evolution of anxiety and depression symptoms using the HADS scale. -To measure changes in catastrophic thinking related to pain using the PCS scale. -To describe the change in the use of healthcare resources (number of medical and nursing visits) after the intervention. -To characterize the sociodemographic and clinical profile of the participants (age, sex, educational level, comorbidities, years since diagnosis, pharmacological treatment).-Study Design:a prospective, longitudinal, quasi-experimental (before-after) analytical study. -Study Setting:urban Primary Care Health Center -Duration:eleven months. -Target Population:adults diagnosed with fibromyalgia and receiving routine follow-up in primary care. -Inclusion Criteria:oPatients diagnosed with fibromyalgia according to ACR criteria. oAge between 18 and 80 years and receiving routine follow-up at the Health Center. oSigned informed consent. -Exclusion Criteria:oSevere cognitive impairment. oUncontrolled psychiatric comorbidity. oSevere communication difficulties. -Sample size and power plan Given the project nature and the uncertainty regarding the achievable sample size (n), the study is planned with a minimum operational sample size of 30 participants as a pilot simple with confidence level α=0.05 and power 80–90% (bilateral),considering pre–post correlation. -Intervention Description:The community education program for fibromyalgia consists of nine monthly group sessions,each lasting approximately two hours. It is designed using a multidisciplinary approach and includes the participation of healthcare and social work professionals,as well as the Afibrocar Association.We are currently performing  the  intervention, results discussion and conclusion will be able by the time of the conferenceWill be able by the time of the conferenceWill be able by the time of the conference