{"id":5880,"date":"2021-03-12T14:17:14","date_gmt":"2021-03-12T13:17:14","guid":{"rendered":"https:\/\/www.profilmedecin.fr\/contenu\/?p=5880"},"modified":"2021-04-29T09:54:34","modified_gmt":"2021-04-29T08:54:34","slug":"democratie-sanitaire-lexpression-perfectible-du-droit-des-usagers","status":"publish","type":"post","link":"https:\/\/www.profilmedecin.fr\/contenu\/democratie-sanitaire-lexpression-perfectible-du-droit-des-usagers\/","title":{"rendered":"D\u00e9mocratie sanitaire : l\u2019expression perfectible du droit des usagers"},"content":{"rendered":"

Depuis bient\u00f4t 20 ans, la d\u00e9mocratie sanitaire a obtenu sa reconnaissance l\u00e9gislative. Si le concept semble aujourd\u2019hui acquis et int\u00e9gr\u00e9 dans la pratique des professionnels de sant\u00e9, des freins emp\u00eachent encore son expression pleine et enti\u00e8re.<\/strong><\/p>\n

La d\u00e9mocratie sanitaire est une d\u00e9marche visant \u00e0 associer l’ensemble des acteurs du syst\u00e8me de sant\u00e9<\/strong>, usagers compris, dans l’\u00e9laboration et la mise en \u0153uvre de la politique de sant\u00e9, dans un esprit de dialogue et de concertation. \u00ab D\u2019un point de vue historique, le grand mouvement de la d\u00e9mocratie sanitaire date des ann\u00e9es VIH<\/em> \u00bb, rappelle le Pr Gr\u00e9goire Moutel<\/strong>, chef du service de m\u00e9decine l\u00e9gale et droit de sant\u00e9 du CHU de Caen, directeur de l\u2019Espace r\u00e9gional de r\u00e9flexion \u00e9thique de Normandie. \u00c0 l\u2019\u00e9poque, les revendications des patients sont claires : ils veulent \u00eatre associ\u00e9s aux recherches et inform\u00e9s des r\u00e9sultats, participer \u00e0 la r\u00e9organisation des parcours de soins jusqu\u2019alors rarement optimis\u00e9s pour eux, \u00eatre associ\u00e9s \u00e0 la d\u00e9marche de soins \u00e0 travers l\u2019obtention de leur consentement et le respect de leurs droits fondamentaux (\u00e0 savoir la non-discrimination, le respect du secret m\u00e9dical, l\u2019acc\u00e8s au dossier m\u00e9dical) et, enfin, avoir la possibilit\u00e9 de d\u00e9signer une personne de confiance. Les associations de patients dans le champ du handicap et de la canc\u00e9rologie ont \u00e9galement \u0153uvr\u00e9 \u00e0 la mise en place de la d\u00e9mocratie sanitaire, qui a trouv\u00e9 sa traduction l\u00e9gislative avec la loi Kouchner du 4 mars 2002.<\/p>\n

Co-d\u00e9cider avec les usagers<\/h2>\n

Faire vivre la d\u00e9mocratie sanitaire implique de d\u00e9velopper la concertation et le d\u00e9bat public<\/strong>, d\u2019am\u00e9liorer la participation des acteurs de sant\u00e9<\/strong> et de promouvoir les droits individuels et collectifs des usagers<\/strong>. \u00c0 l\u2019\u00e9chelle ambulatoire, les Agences r\u00e9gionales de sant\u00e9 (ARS) sont aux manettes avec les conseils territoriaux de sant\u00e9 (CTS). C\u00f4t\u00e9 \u00e9tablissements de sant\u00e9, la loi Kouchner \u00ab oblige \u00bb \u00e0 la mise en place de commissions des usagers (CDU). \u00ab Objectivement, c\u2019est un vrai avantage car les directions sont dans l\u2019obligation de dialoguer, de mettre en place des mesures pour am\u00e9liorer l\u2019accueil des patients, leur \u00e9coute, \u00eatre dans une d\u00e9marche qualit\u00e9 aussi bien concernant les soins que le parcours<\/em> \u00bb, fait savoir le Pr Moutel.
\nPour les professionnels de sant\u00e9, la d\u00e9mocratie sanitaire enclenche \u00e9galement un certain nombre de changements<\/strong> comme une information du patient plus pr\u00e9gnante et la recherche de son consentement au projet th\u00e9rapeutique, qui ne peut plus \u00eatre impos\u00e9 mais doit \u00eatre co-d\u00e9cid\u00e9. \u00ab La notion de paternalisme m\u00e9dical a profond\u00e9ment \u00e9volu\u00e9<\/em> \u00bb, pr\u00e9cise-t-il. Encore plus avec l\u2019\u00e9mergence des patients-experts<\/strong>, qui se voient reconna\u00eetre, par les professionnels de sant\u00e9, des savoirs et des comp\u00e9tences en lien avec leur maladie. \u00ab Dans le domaine de la recherche aussi la d\u00e9mocratie sanitaire a conduit \u00e0 des avanc\u00e9es, car lorsqu\u2019un soin, un m\u00e9dicament, une technique sont \u00e9valu\u00e9s, on s\u2019attache d\u00e9sormais \u00e0 mesurer \u00e9galement la qualit\u00e9 de vie des patients<\/em> \u00bb, fait savoir le Pr Moutel.<\/p>\n

Des efforts \u00e0 maintenir<\/h2>\n

\u00ab Globalement, la notion de d\u00e9mocratie en sant\u00e9 est plut\u00f4t bien appliqu\u00e9e sur l\u2019ensemble du territoire<\/strong><\/em>, poursuit le Pr Moutel. Les futurs professionnels de sant\u00e9 y sont d\u2019ailleurs form\u00e9s dans le cadre de leur cursus et sur le terrain cela se ressent.<\/em> \u00bb N\u00e9anmoins, il existe toujours des dysfonctionnements.<\/strong> \u00ab Par exemple, certains patients ne parviennent pas \u00e0 obtenir leur dossier m\u00e9dical, fait-il savoir. L\u2019avantage, c\u2019est qu\u2019aujourd\u2019hui la loi les aide \u00e0 combattre les obstacles.<\/em> \u00bb
\nEn ville aussi la mise en \u0153uvre de la d\u00e9mocratie sanitaire essuie quelques retards en raison de l\u2019absence d\u2019obligation d\u2019instaurer des comit\u00e9s des usagers dans les structures ambulatoires ainsi que pour des questions de contraintes organisationnelles. Le d\u00e9ploiement des Communaut\u00e9s territoriales professionnels de sant\u00e9 (CPTS) pourrait \u00eatre la porte d\u2019entr\u00e9e \u00e0 cette plus grande expression<\/strong>. \u00c0 condition de tenir compte de toutes les pathologies, car \u00ab certaines sont moins bien repr\u00e9sent\u00e9es par les structures associatives que d\u2019autres, et la gouvernance doit veiller \u00e0 n\u2019oublier aucun usager<\/em> \u00bb, pr\u00e9vient le Pr Moutel.<\/p>\n

D\u00e9mocratie sanitaire : quels points de vue ?<\/h2>\n

Pour aller plus loin :<\/p>\n

\u00ab\u00a0\u00c0 l’h\u00f4pital, la collaboration avec les usagers fait \u00e9voluer la pratique m\u00e9dicale.\u00a0\u00bb<\/a>
\n\u00ab\u00a0En m\u00e9decine de ville : apprendre \u00e0 soigner autrement\u00a0\u00bb<\/a>
\n\u00ab\u00a0Le point de vue des repr\u00e9sentants des usagers\u00a0\u00bb<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"Depuis bient\u00f4t 20 ans, la d\u00e9mocratie sanitaire a obtenu sa reconnaissance l\u00e9gislative. Si le concept semble aujourd\u2019hui acquis et int\u00e9gr\u00e9 dans la pratique des professionnels de sant\u00e9, des freins emp\u00eachent encore son expression pleine et enti\u00e8re. La d\u00e9mocratie sanitaire est une d\u00e9marche visant \u00e0 associer l’ensemble des acteurs du syst\u00e8me de sant\u00e9, usagers compris, dans… Voir l’article<\/a>","protected":false},"author":1,"featured_media":5882,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[15,2],"tags":[143,141,142],"class_list":["post-5880","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-actualite","category-dossiers","tag-democratie-sanitaire","tag-dossier","tag-patient-expert"],"yoast_head":"\nD\u00e9mocratie sanitaire : l\u2019expression perfectible du droit des usagers | Profil M\u00e9decin<\/title>\n<meta name=\"description\" content=\"Depuis bient\u00f4t 20 ans, la d\u00e9mocratie sanitaire a obtenu sa reconnaissance l\u00e9gislative. 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