Background The association between precariousness and lack of access to health care is well-documented. Prescribing drugs is one promising marker for this health care inequality. A recent study, carried out on the entire French population, has developed a new measurement model based on the 20 most prescribed molecules. It reports that drugs, targeting diseases known to more affect precarious populations, are under-prescribed by general practitioners (GP) to these populations. If these findings highlight unequal drugs prescriptions between populations despite epidemiological factors, it is still unknown whether a high and daily exposure to precariousness negatively impacts GPs prescriptions. Here, we investigated whether there are more inequalities in prescriptions of GPs who are highly and daily exposed to precariousness, compared to GPs who are less exposed to precariousness. Methods This retrospective pharmaco-epidemiological study compared the Defined Daily Dose relative to different reimbursed drugs prescribed by GPs to precarious and non-precarious patients in four French regions respectively with low and high precariousness prevalence in 2015. Data were analyzed using repeated-measures ANOVAs (Sphericity correction: Greenhouse-Geisser; Post-Hoc Tests, Bonferroni corrected). Results 2 out of 20 molecules were significantly over-prescribed (tamsulosine and timolol) and 7 were under-prescribed (amoxicillin, econazole, ciclopirox, prednisolone, paracetamol, cromolyn sodium, ibuprofen) to precarious populations in regions with high precariousness prevalence. Conclusions The over-reimbursement of tamsulosine and timolol did not reflect the negative impact of exposure to precariousness on the GPs prescriptions but a failure of the health system to compensate for inequalities in access to chirurgical treatments. In contrast, the under-reimbursement of amoxicillin, ciclopirox and econazole indicated an effect of the exposure to precariousness on GPs’ prescriptions, these molecules targeting acute diseases that affect more significantly precarious than non-precarious populations. The same explanation is probably suitable for the under-reimbursement of prednisolone, paracetamol, cromolyn sodium, and ibuprofen, although their various indications render difficult to delimitate the clinical purpose at the basis of their prescription. We assume that exhausting working conditions, repeated exposures to difficult living conditions, and repeated experiences of failure impairs empathic skills in GPs, leading to burnout which negatively impacts the quality of care and, thus, prescriptions.

(1) Background: Precarious patients are more difficult to care for due to low literacy rates and poor adherence to treatment and hospitalization. These difficulties have detrimental effects on general practitioners (GPs), deteriorating medical communication, advice, diagnoses, and drug prescriptions. To better understand how precariousness affects primary care, we tested whether, among GPs, exposure to high precariousness prevalence more severely impacts drug prescriptions to precarious and non-precarious populations compared to low precariousness prevalence. Materials and methods: This pharmaco-epidemiological study, using linear regression analyses, compared the defined daily dose of 20 drugs prescribed by GPs to precarious and non-precarious patients in four French regions with low and high precariousness prevalence in 2015. (2) Findings: Exposure to high precariousness prevalence significantly impacted the prescriptions of nine medications to precarious patients and two medications to non-precarious patients, and distributed into three interaction patterns. (3) Interpretation: The selective over-prescription of drugs with easy intake modalities to precarious patients probably reflects GPs’ attempts to compensate for poor patient compliance. In contrast, the under-prescription of drugs targeting fungal infections in precarious populations and diabetes and cardiovascular diseases in non-precarious populations was seemingly due to a breakdown of empathy and professional exhaustion, causing medical neglect.