Abstract
At the time of “ambulatory shift”, new modes of care are developing: this is the case of the mobile teams of physical and rehabilitation medicine (PRM) [LJ1] who participate in diversification of health care facilities. They concern disability (whatever its origin) and actions for short or medium stay, links between private and hospital practice, medico-social, care pathway and the absence of breach for this complex patient. The objective is to encourage out of hospital care, as far as possible, in all actions waged. Our mobile team “EMT3R 69” (territorial mobile team of rehabilitation, reintegration) is multidisciplinary (Physician PRM, occupational therapist, physiotherapist, social worker) and was created in January 2017. It is funded by the regional health agency “ARS” for a period of 3 years. Application for Team's intervention must contain specific objectives. A rapid response is provided in order to found the most appropriate response. After 1 year experience, 121 persons (58% of men) were included corresponding to 682 interventions, among which 193 in the living place. Other interventions comprised follow-up to the recommendations, coordination with the partners,…). Patients were heavily dependent (RANKIN 4), mainly neurologically disabled (92%), living at home (66.8%) or in a medico-social institution (27.4%). Sixty-eight percent benefited from information/recommendations on technical assistance of all types, 33% were helped/oriented in administrative procedures related to disability and 29% were redirected to medical professionals or other adapted structures. The creation of this team (and 6 other ones in Rhône-Alpes) allows responding to several priorities of public health: “facilitate access to an adapted and efficient healthcare offer”, “make care pathway more fluid”. After more than a year of experience, improvement will be set up particularly in supporting caregivers and then in terms of territorial coverage and network development.
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