Face aux problématiques d’accès, de désertification médicale et de qualité des soins, la loi « Hôpital, Patients, Santé, Territoires » (HPST), votée en 2009, représente un socle pour la réorganisation des soins primaires en France. L’accent est mis sur la collaboration entre les professionnels de santé et l’optimisation des compétences de chacun. Le pharmacien d’officine se trouve au coeur de cette loi. Grâce à son accessibilité, sa formation et sa proximité avec les patients sains comme malades, il voit l’opportunité d’étendre ses pratiques au-delà de la simple dispensation des médicaments en fournissant directement des soins au patient. Cette proposition n’est pas une exception française mais s’inspire des expériences internationales et du concept de « soins pharmaceutiques ». Le pharmacien écossais peut désormais être payé à la capitation pour délivrer des consultations pharmaceutiques lors du renouvellement d’ordonnance au patient atteint de maladie chronique; le pharmacien anglais peut prescrire des médicaments dans le cadre d’un plan de gestion clinique et recevoir un honoraire de dispensation; le pharmacien suisse peut organiser des réunions de discussion avec les médecins; et le pharmacien portugais peut vacciner son patient au sein de l’officine. Les illustrations de la diversification des pratiques du pharmacien d’officine sont donc variées et se replacent dans leur contexte national. L’enjeu est aujourd’hui de comprendre les conditions et les effets d’un ensemble d’innovations techniques, organisationnelles et sociales qui pourraient être en faveur du développement des soins pharmaceutiques en France. Ce travail de thèse a pour objectif de nourrir les débats autour de cette problématique. Un état des lieux de la profession en France et une enquête d’opinion auprès des futurs pharmaciens montrent que le contexte sanitaire, professionnel, économique est propice au développement des pratiques du pharmacien et que l’avenir des soins pharmaceutiques trouve un écho favorable auprès des pharmaciens de demain. Cependant, nombreux sont les facteurs qui peuvent constituer des obstacles à leur diffusion (Chapitres 1 et 2). D’un point de vue économique, d’après une revue de littérature systématique sur l’efficience des soins pharmaceutiques en Europe, les services de surveillance médicamenteuse, de médication officinale, de collaboration entre les professionnels de santé et de promotion de la santé pourraient être, dans certaines conditions, des interventions coût-efficaces d’un point de vue collectif (Chapitre 3). Mais qu’en est-il en France ? On ne dispose pas de travaux sur le sujet. Deux travaux originaux - une étude de cohorte (exposés/non exposés) et une analyse coût-efficacité -, que nous avons menés, se focalisant sur l’implication du pharmacien d’officine dans le dépistage d’une maladie chronique (le syndrome d’apnées du sommeil) montrent que les coûts engendrés par la mise en place d’une telle intervention sont sous certaines conditions compensés par les gains générés, et les résultats sont en faveur de l’implantation du service en pratique de routine (Chapitre 4). / Facing the issues of access, quality and proximity, the "Hospital, Patients, Health and Territories" (HPST) law, passed in 2009, constitutes a basis for the reorganization of primary care in France. The healthcare reform emphasizes on the collaboration between healthcare professionals and the optimization of their skills. The community pharmacist is on the forefront of this reform. Through its accessibility, its training and its proximity with healthy and sick patients, community pharmacists have the opportunity to broaden the scope of their practices beyond the merely dispensing of medication by delivering patient care. This proposal is not a French exception but takes inspiration from international experiences and the concept of "pharmaceutical care." The Scottish pharmacist can now be paid by capitation to renew a prescription for a patient with chronic illness; the English pharmacist can prescribe medication as part of a clinical management plan and receive a dispensing fee, the Swiss pharmacist can organize meetings with general practitioners and in Portugal, pharmacists can vaccinate a patient in the pharmacy. Pharmaceutical care practices are diversified and depend on national context. The challenge today is to understand the conditions and consequences of technical, organizational and social innovations that could be in favor of the development of pharmaceutical care in France. The objective of the thesis is to feed into the debates around this problematic. An overview of profession in France and an original opinion survey of future pharmacists show that the healthcare, professional and economic contexts are suitable to develop pharmaceutical care and future pharmacists are in favor of it. However, there are many barriers to their spread in routine practice (Chapters 1 and 2). From an economical perspective, a systematic review of the literature on the efficiency of pharmaceutical care in Europe show that drug monitoring services, prescription for minor ailments, collaboration between health professionals and health promotion interventions could be cost-effective from a collective point of view under certain conditions (Chapter 3). What about France? There is no study on this topic. We conducted two original studies - a cohort study (exposed / unexposed), and a cost-effectiveness analysis which focused on the involvement of the pharmacist in screening for chronic disease (sleep apnea syndrome). We show that the costs of implementing such an intervention are offset by the gains under certain conditions, and the results are in favor of the implementation of the service in routine practice (Chapter 4).

Whether it is offering services, delivering solutions or driving innovations, team work has been a hallmark of efficiency and effectiveness in various industries. The healthcare industry is not left out as its service delivery process involves numerous interfaces, information flows and patient hand-offs among professionals with different educational training, differing knowledge levels and possibly working from different locations as well. As healthcare delivery evolves to being more patient-centered, so does the team settings as well, becoming more collaborative. Such changes also translate into a need for support systems to evolve to be able to provide support for the extent of collaboration that would be needed. A framework is needed to guide in the development of such systems. However, due to the varying needs of patients, team types and make-up would generally differ, so we explored the different types of team settings studying what they entail based on their various degrees of collaboration. We therefore present in this thesis a model of team based concepts, an ontology formalizing the model, team based scenarios designed using the ontology and then application of the scenarios to test the ability of BPMN (Business Process Modeling Notation) to model healthcare teams.

Whether it is offering services, delivering solutions or driving innovations, team work has been a hallmark of efficiency and effectiveness in various industries. The healthcare industry is not left out as its service delivery process involves numerous interfaces, information flows and patient hand-offs among professionals with different educational training, differing knowledge levels and possibly working from different locations as well. As healthcare delivery evolves to being more patient-centered, so does the team settings as well, becoming more collaborative. Such changes also translate into a need for support systems to evolve to be able to provide support for the extent of collaboration that would be needed. A framework is needed to guide in the development of such systems. However, due to the varying needs of patients, team types and make-up would generally differ, so we explored the different types of team settings studying what they entail based on their various degrees of collaboration. We therefore present in this thesis a model of team based concepts, an ontology formalizing the model, team based scenarios designed using the ontology and then application of the scenarios to test the ability of BPMN (Business Process Modeling Notation) to model healthcare teams.

Whether it is offering services, delivering solutions or driving innovations, team work has been a hallmark of efficiency and effectiveness in various industries. The healthcare industry is not left out as its service delivery process involves numerous interfaces, information flows and patient hand-offs among professionals with different educational training, differing knowledge levels and possibly working from different locations as well. As healthcare delivery evolves to being more patient-centered, so does the team settings as well, becoming more collaborative. Such changes also translate into a need for support systems to evolve to be able to provide support for the extent of collaboration that would be needed. A framework is needed to guide in the development of such systems. However, due to the varying needs of patients, team types and make-up would generally differ, so we explored the different types of team settings studying what they entail based on their various degrees of collaboration. We therefore present in this thesis a model of team based concepts, an ontology formalizing the model, team based scenarios designed using the ontology and then application of the scenarios to test the ability of BPMN (Business Process Modeling Notation) to model healthcare teams.

Whether it is offering services, delivering solutions or driving innovations, team work has been a hallmark of efficiency and effectiveness in various industries. The healthcare industry is not left out as its service delivery process involves numerous interfaces, information flows and patient hand-offs among professionals with different educational training, differing knowledge levels and possibly working from different locations as well. As healthcare delivery evolves to being more patient-centered, so does the team settings as well, becoming more collaborative. Such changes also translate into a need for support systems to evolve to be able to provide support for the extent of collaboration that would be needed. A framework is needed to guide in the development of such systems. However, due to the varying needs of patients, team types and make-up would generally differ, so we explored the different types of team settings studying what they entail based on their various degrees of collaboration. We therefore present in this thesis a model of team based concepts, an ontology formalizing the model, team based scenarios designed using the ontology and then application of the scenarios to test the ability of BPMN (Business Process Modeling Notation) to model healthcare teams.