Consultations of hospital physicians in community health centers: Actors’ identified impacts and difficulties

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Objective: In 2016 different types of cooperation were identified between “Assistance publique – Hôpitaux de Paris” and community-based healthcare professionals, including consultations from hospital practitioners in community health centers. This work aims to study the advantages and difficulties of this type of cooperation. Methods: Interviews were conducted with hospital physicians, heads of hospital units and of community health centers. Data were collected by physicians for seven consultations. Results: Regarding patients, these consultations gave access to specialists’ expertise in deficit areas at no extra cost; the community health center is a more human-size structure and appointments were sometimes more quickly attributed. For physicians, consulting in the community health center afforded a more diversified activity and permitted to discover community practice. For the hospital unit, it could bring new patients and lead some patients living closer to the community health center to delocalize the follow-up consultations. This type of cooperation strengthened the relation between hospital and community-based practitioners but the relations remained informal. Amongst mentionable difficulties: the lack of information systems interoperability, the struggle in raising the interest of some physicians and an increased workload. Conclusion: If this type of consultation can be a first step in organizing hospital-community relations, it does not enable by itself a territorial coverage. Partnerships should include several community health centers but also physicians in independent practice. Larger partnerships can integrate the formalization of care pathways refocusing each actor on its field of expertise.