Background: The present challenge for patient involvement is the improvement of healthcare efficiency through a deeper consideration of the patient experience. In hospitals, numerous interventions promoting patient involvement are informally implemented by healthcare workers (HCWs). The first aim of this study was to conduct an overview of hospital HCWs' experiences of the involvement of patients or their representatives. This overview included the involvement of patients in the domains of healthcare provision and support for other patients, healthcare quality and safety improvement, training and research. The second aim was to describe the challenges and conditions for the development of participative interventions by HCWs. Methods: We conducted a mixed-methods sequential study at Nantes University Hospital from September 2017 to May 2018. To achieve the first aim, we performed a descriptive analysis of quantitative data collected via a questionnaire survey of 1290 HCWs. To achieve the second aim, we conducted a thematic analysis of qualitative data collected via eight semi-structured interviews with HCWs who reported involving patients or their representatives (family and patient association members) in healthcare. Results: Among the 213 survey participants (16.5%), 133 reported a total of 424 participative interventions, mostly in the domains of care quality and safety (37%) and care provision and support (29%). The analysis of the qualitative data evidenced three types of factors determining the implementation of such interventions: the profiles of patients and their representatives, the beliefs and attitudes of HCWs, and organisational factors. While leadership from patients and HCWs was a central element in the development of patient involvement interventions, organisations' capacities to foster a sustainable partnership culture appeared to be the next challenge to promote the patient-as-partner model in health systems. Our results also highlighted numerous benefits of patient and representative involvement for patients and HCWs.

Objectives To describe and analyse studies aiming at quantitatively assessing the impact of interventions on patient-reported burden of treatment as an outcome (primary or secondary). Methods The aim of the search strategy was to identify all publications describing a medical intervention intended to reduce patient-reported burden of treatment in adult patients with long-term conditions, from January 1, 2008 to July 15, 2019. Four databases (Medline, PsycINFO, the “Trials” section of the Cochrane-Library, and OpenGrey) were searched in English, French, Spanish, Italian and Portuguese. Each identified article was reviewed and the risk of bias was assessed using a tool adapted from the Cochrane Collaboration recommendations. Results Of 641 articles retrieved, 11 were included in this review. There were nine randomized controlled trials, one non-randomized controlled trial, and one before-and-after study. The sample sizes ranged from 55 to 1,546 patients. Eight out of the eleven studies reported significant positive outcomes of the studied interventions. Reducing dosing frequency, improving background therapy, offering home care or providing easier-to-use medical devices were associated with positive outcomes. Conclusions Only a few studies have specifically focused on decreasing the subjective burden of treatment. Small trials conducted in patients with a single specific disorder have reported positive outcomes. However, a large, high-quality study assessing the impact of a change in care process in patients with multiple morbidities did not show such results. Further studies are needed to implement this aspect of patient-centred care.

Objectif : L’Espace Santé Jeune (ESJ) est un projet d’éducation pour la santé mené́ depuis 2008 dans un collège français. Les collégiens sont invités à participer à des espaces de parole sur la santé, animés par un médecin généraliste (MG) accompagné d’un animateur jeunesse de la commune ou d’un enseignant. Cette étude cherche à comprendre le rôle des médecins et à identifier les leviers du projet à partir du vécu des acteurs. Méthode : Une étude de méthode mixte a été menée de janvier à juin 2015 par entretiens collectifs, individuels et questionnaire. Les résultats de l’analyse inductive par théorisation ancrée ont été confrontés aux résultats quantitatifs. Résultats : 30 participants ont été inclus dans l’enquête qualitative (20 élèves, 5 enseignants, 4 MG, 1 animateur jeunesse) et 107 élèves ont répondu au questionnaire (taux de réponse 71 %). L’ESJ est un espace centré sur la parole des jeunes, vécu comme un moment de liberté et apprécié par 70 % des participants. Le rôle des MG pendant les séances oscille entre « animation des débats » et « expertise », et la complémentarité des compétences avec les professionnels éducatifs facilite leur intervention. Au-delà des séances, la présence des MG est perçue comme indispensable car leur statut amène une légitimité globale au projet. L’intervention repose sur l’engagement des professionnels, la pluri-professionnalité, la coordination et le partage d’une culture commune de la prévention. Conclusion : L’ESJ est une expérience originale encourageant l’investissement de MG dans des actions locales de santé publique.

In patients with substituted hypothyroidism, laparoscopic sleeve gastrectomy may interfere with thyroid balance by varying body weight or by altering the absorption of hormone therapy. A 58-year-old female patient presented with a major thyroid imbalance after sleeve gastrectomy, manifesting itself in large-scale changes in thyroid stimulating hormone (TSH) levels. The transition from a tablet treatment to a liquid form alleviated burden of treatment, unfortunately without normalising TSH. Our case emphasises the importance of the understanding of hypothalamic–pituitary–thyroid feedback control mechanisms together with good galenic choice, management of associated conditions and the elimination of other causes of variations of TSH levels during the management of hypothyroid patients after sleeve gastrectomy.