Diabetes, overweight, smoking… threat to the Asalée, these nurses so precious to doctors and chronically ill people
For twenty years, Asalée nurses have significantly improved the care of chronically ill patients. For administrative reasons, the development of the network is today paralyzed, and those who participate in it are considering leaving. At the Saint-Georges d'Orques health center, Manon Gingand has nevertheless made herself indispensable.
Jean-Pierre Agret, a teacher, halved his tobacco consumption and returned to sport. Mireille Hugon, 79, constantly out of breath, started walking again. Valérie Journet, 57, diabetic, reviewed her diet and diet. “Without Manon, we wouldn’t have made it”say, with one voice, the patients of the Saint-Georges d'Orques health center (Hérault), rave about the skills and kindness of Manon Gingand, their nurse.
“Without Manon, I would not have been able to take on so many patients, 2022 only as an attending physician compared to an average of 800 patients in France. With her, I have peace of mind, I know that what will not be understood will be taken up, and what was not said because they did not dare to ask the question will be.” adds Béatrice Lognos, doctor at the MSP.
In two and a half years, Manon Gingand, who works in a long-term relationship with patients, three quarters of an hour to an hour for a consultation, group workshops, activities outside the health home as good against diseases as well as for social bonds, has become essential.
Her status has a lot to do with it: she is an Asalée nurse (for Liberal Team Health Action), linked by an agreement with each of the three MSP practitioners. The little-known device has proven itself for twenty years. It is today weakened by administrative problems which call into question its sustainability.
Asalée, what are we talking about?
2,080 nurses have now entered the Asalée system in France, 244 in Occitanie on the basis of a cooperation protocol between general practitioners and nurses delegated to public health, whose role will be to improve the caring for patients who suffer from chronic illnesses.
Operation is based on an agreement between the Asalée association and Health Insurance, nurses have a fixed income. Since 2022, they have worked outside of the agreement, due to lack of agreement on the conditions of practice of the profession. The Asalée were also excluded from the Ségur de la santé salary increases.
According to a study by Irdes (Institute for Research and Documentation in Health Economics), the presence of an Asalée makes it possible to increase the active queue in general medicine by 7% per quarter. The saving in healthcare consumption is estimated at 10%.
“All projects are blocked”
“I work in pairs with each of the doctors to support their patients suffering from chronic diseases, with diabetes, overweight, obesity… and I intervene in the screening of cognitive diseases, but also asthma and COPD”recalls Manon Gingand.
The nurse is particularly attentive to the situation of new patients, those over 65 who are vulnerable, and children aged 4 to 6 who require screening.
“The Asalée system is based for once on a need in the field, for which we sought suitable monitoring”welcome the nurse and doctors. “There is real added value in sharing skills, which allows different and completely coordinated support. Today, all projects are blocked due to lack of visibility”they regret. “I ask myself the question of continuing in the current conditions”admits Manon Gingand, that Asalée had “reconciled with the nursing profession”, “it saved my career, without Asalée, I would no longer be a nurse”.
“It’s an extraordinary association for quality care, which allows me to free up time for new patients, we can’t go back,” worries Dr Emelin Collart-Dutilleul, from the MSP of Saint-Georges d’Orques.
“Without Manon, we explode”
“I can't be everywhere at the same time given the shortage of doctors, but I know today that the necessary time will be devoted to my patients. For their part, they have the impression of being truly taken care of and they have the tools to take charge of themselves, independently. Without Manon, we explode.” adds Dr Lognos.
As for the patients, they risk giving up everything. “I wasn’t really motivated, I mainly wanted to please Dr. Lognos”remembers Jean-Pierre Agret, 65, who now walks “every day”and took up mountain biking: “I took charge of myself thanks to Manon, she is caring, competent, fair.”
“I joined a group on diet and another on diabetes… I take care of myself”, notes Valérie Journet, for a long time in a form of denial of her diabetes who this time had the listening time necessary to cope: “I had trouble accepting the illness, and we can't spend time with the doctor, it's complicated, I know he's overworked. With Manon, I don't feel guilty about the time spent.”
“If Manon had not accompanied me, I would never have walked, I have osteoporosis, I am afraid of falling. We both started again for three months, then the group grew”, testifies Mireille Hugon. Retired from Health Insurance, she knows all too well the benefits.