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1
Docteur Jean Pauluis,
Maître de conférences à la Faculté de Médecine de Liège.2 octobre 2010
KwaliteitsdagLa journée de la qualité
05 03 2011
SSMG Domus medica
Gerico, a communication tool for the general practitioners and the
citizens in case of local environmental and health (E&H)
exposure .
2
GERICO.Gestion of the Risk and Communication.
www.hector-asbl.be
• The pursued objective is to find multidisciplinary solutions to face environment-health problems between local, medical, scientific and political actors.
• The communication constitutes the keystone of the process of social acceptability of any public decision in risk, particularly in situation of uncertainty.
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Create an expertise and a decision-making support.
• Gerico plans to collect the opinions and the points of view of various experts (doctors, GP’s, sociologists, economists, environmentalists, jurists, ngo’s…) in the optics of the search for a consensus between all these actors.
• In case of disagreement, the positions of some and the others will be clarified and a reflection will be introduced about the process of communication.
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Experts' quarrels and communicationSource: Le Généraliste le 17 février 1999 page 3
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Contribution of the EU: Strategy environment-health,
SCALE in June, 2003
• Collaboration between 3 DG of the Commission• Development of an approach based on science
(Science)• Centred on the children ( Children)• Bringing to awareness raising ( Awareness)• Using the legal instruments (Legal instrument)• Planning a permanent evaluation (Evaluation)
– Implementation of the strategy by successive actions plans
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Option 6: Actions for improved communication and education (1) TWG Biomonitoring of children SCALE 2004
Endorse actions to ensure high-quality information exchange, using E&H IS (information system):
• Communication strategy• Develop tools to increase communication (eg
policymakers, E&H professionals, public) • Develop clear, easy-to-use information, processed at
every step of policy-making process– Pros: increased understanding different stakeholders,
awareness raising; education, balanced and transparentdecision-making; targeted preventive policy, cost-effective
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GEstion du RIsque et COmmunication (GERICO)
1. Demande d’accès à la zone privée
Communication sur les risques Identification
et examen des options
Evaluation des risques
Evaluation du processus
et des interventions
Mise en œuvre des
interventionsChoix
de la stratégie
Définition des problèmes
et des contextes
Groupe opérationnel
Pouvoir régional
Comité scientifique indépendant
Médecins de l’entité Pouvoir communal
Leaders d’opinion Grand public
Zone de consensus
GERICO
Comité de coordination
Communication étendue GERICO www.hector-asbl.be
Court terme : phase de test sur une problématique loco-régionale avec des acteurs intéressés de façon à réaliser un test grandeur nature et finaliser les fonctionnalités de l’outilMoyen terme : mettre l’outil à disposition des autorités loco-régionales moyennant la conclusion d’un protocole d’accord de services entre Hector et ces autoritésLong terme : développer des versions multilingues permettant d’utiliser l’outil au-delà de la francophonie.
L’avenir…
La méthode…
La théorie…
2. Login et mot de passe introduits
3. Choix du thème à discuter
4. Choix de la grille de lecture
5. Lecture des brèves et des résumés
6. Analyse des documents originels
7. Réaction sur les documents ou résumé
8. Participation à un forum de discussion
9. Proposition de documents
ConfidentialitéCharte à signer
Déontologie
Modérateur
10. Dégagement de solutions pluridisciplinaires dans un processus itératif
Convention d’Aarhus
Loi du22 août 2002.Droit du patient Art.7§1.
Convention d’Aarhus
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GEstion du RIsque et COmmunication (GERICO)
Un nouvel outil de communication et de participation au niveau local.
Dr. J. Pauluis, P. Biot, M.C. Lahaye
La théorie…
Communication sur les risques
Identification et examen des options
Evaluation des risques
Evaluation du processus
et des interventions
Mise en œuvre des
interventions
Choix de la stratégie
Définition des problèmes
et des contextes
9
GEstion du RIsque et COmmunication (GERICO)
Un nouvel outil de communication et de participation au niveau local.
Dr. J. Pauluis, P. Biot, M.C. Lahaye
Groupe opérationnel
Pouvoir régional
Comité scientifique indépendant
Médecins de l’entité Pouvoir communal
Leaders d’opinion Grand public
Zone de consensus
GERICO
Comité de coordination
Communication étendue GERICO www.hector-asbl.be
Convention d’Aarhus
Loi du22 août 2002.Droit du patient Art.7§1.
Convention d’Aarhus
10
•
1. Demande d’accès à la zone privée
2. Login et mot de passe introduits
3. Choix du thème à discuter
ConfidentialitéCharte à signer
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4. Choix de la grille de lecture
5. Lecture des brèves et des résumés
6. Analyse des documents originels Déontologie
12
7. Réaction sur les documents ou résumé
8. Participation à un forum de discussion
9. Proposition de documents
10. Dégagement de solutions pluridisciplinaires dans un processus itératif
Modérateur
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1- The risk
2- The obligation to communicate
3- The communication
THREE
NOTIONS
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1989 : Les liens entre environnement et santé
15
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La gestion du risqueIDENTIFICATION D U
DANGER
effe ts, c iné tiques
RELATIONS DOSE-REPONSE
seuils d' ef fets, fac teurs de
sécurité
EXPOSITION
nom bre , durée , espace ,
concentra tions, fonctions de
transformation, diffusion
APPRECIATION
com paraison avec d' autres
r isques, acceptabilité , choix
politiques, ana ly ses
coûts/bénéf ices
ESTIMATION DU DANGER
ESTIMATION DU RISQUE
GESTION DU RISQUE
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1- The risk
2- The obligation to communicate• For legal reasons
• For deontologic reasons
• For ethical reasons
3- The communication
THREE
NOTIONS
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AarhusCommission économique pour l ’Europe.
CONVENTION SUR L'ACCES A L'INFORMATION, LA PARTICIPATION DU PUBLIC AU PROCESSUS DECISIONNEL ET
L'ACCES A LA JUSTICE EN MATIERE D'ENVIRONNEMENT.
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The medical environmental information and its difficulties.
• Can we accept the minimization of the risks by fear " of terrifying the population "?
• Accepting this minimization does it engage the responsibility of the general practitioner?
• For the general practitioner where to find a fast, objective and validated information?
• How long can we wait for the "validation" of the contents?
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The ruling " Hédreul " in February 25th, 1997
1st civil appeal division of a superior court of the Highest Court of Appeal - France
• Reversal of the burden of proof of the information.
• Health-environment = management of the uncertainty
" The general practitioner is held by a particular obligation of information towards his patient and he has to prove that he executed this obligation . "
21
Law of August 22nd, 2002 relative to the rights of the patient. Belgium
" Art 7 §1er: the patient is entitled, on behalf of the professional practitioner, to all the information which concern him and can be necessary for him to understand his health and its likely evolution ".
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Information and transparency.(1) Source.Pr G.Sokal - Bureau national de l Ordre des Médecins - Le généraliste - 31 mars 1999.
« Il est du devoir du médecin d’avertir sans ambages et dans une pleine transparence, c’est-à-dire en ne celant aucun renseignement valable et utile, toute personne du risque auquel elle est exposée suite à la pollution de l’environnement. Il est tout autant de son devoir, comme celui de tout citoyen, d’en avertir les autorités responsables. »
" It is of the duty of the doctor to warn frankly and in a full transparency, he can’t hide valid and useful piece of information, to every person of the risk to which he is exposed further to the environmental pollution. It is necessary just as much of its duty, as that of every citizen, to warn the responsible authorities of it. "
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Information and transparency (2) Source.Pr G.Sokal - Bureau national de l Ordre des Médecins - Le généraliste - 31 mars 1999
" We can only recommend the dialogue (concertation) of the
general practitioners of a region or a community when a problem
of pollution arises. "
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Information and transparency (3)Source.Pr G.Sokal - Bureau national de l Ordre des Médecins - Le généraliste - 31 mars 1999
" The information must be complete including the part of
uncertainty, towards those who are responsible in the front line for
the health: the general practitioners. "
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1- The risk
2- The obligation to communicate
3- The communication
THREE
NOTIONS
Integration of environment and health.TWG Biomonitoring of children SCALE 2004
• Human biomonitoring is an excellent tool to better integratethe two fields, environment and health
• One of its big advantages is that within the
chain it is much closer to health effects than environmental monitoring
Biomarker of susceptibility
Biomarkers of exposure
Internal dose
Biological effective dose
Biomarker of effect
Early response
Altered structure and funcion
Disorder Disease
Exposure EmissionEnvironmental
concentration
• Gerico domain of action
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Objectives for Action Plan 2004-2010 in thefield of environmental and health links.TWG
Biomonitoring of childrens SCALE 2004
• endorse activities to establish standardised E&H Indicatorreporting and assessment
• set up decision-making process to support progressive development of E &H information system (national/regional level)
• Improve access to information, communication andeducation
• Involve all stakeholders in building-process
• Set up mechanisms to Ensure Rapid, Accurate and EfficientIterative Updating of Monitoring Programmes and Policy Measures.
28
A more harmonised biomonitoringapproach.
TWG Biomonitoring of childrens SCALE 2004
• Comparability would contribute to the EU Strategy for E & H by:
– Providing data on distribution of exposure and related health impact across Europe
– definition of reference values– detection of spatial differences in exposure (populations/regions at
risk) – detection of temporal differences in exposure
– Providing policy makers with better information on control measures to be taken
– identification of priorities in exposure reduction strategies
– allowing follow up of the efficiency of reduction strategies, – allowing a geographically differentiated E&H policy
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• Carrying out large (or local) surveys that include human biomonitoring presents challenging logistical problems and generally cannot be done without having medical staff available.
Problems.
TWG Biomonitoring of childrens SCALE 2004
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Research needs TWG Biomonitoring of childrens SCALE 2004
• Research on socio-ethical and legal constraints
It is increasingly recognized that medical ethics, originated anddeveloped for clinical situations, may require modification forpublic health or community needs, taking into account the“public interest” of the outcome of biomonitoring surveys.
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ETHICS TWG Biomonitoring of childrens SCALE 2004
• Informed consent: authenticity of consent– Who should ask for consent?– Who should give the information and how, written, video, oral, updates regularly – How to treat “given consent” in long term follow up studies?
• Right to know & right not to know
– Communication of results when link with health risk is not clear – Communication of individual results or aggregated data?
• ....
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The Belgian NEHAP. What role for the general practitioners?
• Establish a functional collaboration between the existing structures in the domains of the environment and the health;
• Develop and manage databases concerning all the aspects environment-health;
• Define the priorities of search(research) on the relations between the environment and the health;
• Develop a prevention policy;• Develop a policy of communication;• Support the development of course and trainings on the
relations between the environment and the health;• Make sensitive and educate in the relations between
environment and health.
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• Diffuser of information.
• Detector of symptoms.
• Social mediator.
* Concern for Europe ’s Tomorrow 1995 - OMS
The communication of the risk (E&H) by the general practitioner
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Conclusion.Develop tools to translate results into a
response system TWG Biomonitoring of childrens
• In order to translate the results of biomonitoring into effective policy measures, effective communication is needed.
• Effective communication needs participation and exchange between the different stakeholders (general
public, study participants, general practitioners, regulators, scientists, public interest NGO’s, industry, others) and will promote public awareness.
• A communication plan is an essential part of a biomonitoring programme and should be a part of the study design.
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The future of GERICO?
• Short term: phase of test on a loco-regional problem with actors interested so as to realize a life-size test and finalize the features of the tool
• Middle term: give tool of the loco-regional authorities for the conclusion of a draft agreement of services between Hector and these authorities
• Long term: develop multilingual versions allowing to use the tool beyond the Francophony.