Étude prospective des caractéristiques médicopsychosociales de 350 patients ayant consulté une permanence d’accès aux soins de santé en 2002

Blanchardière, A. de La; Méouchy, G; Brunel, Patrick; Olivier, Philippe

doi:10.1016/j.revmed.2003.09.004

Cited by 8 publications

(2 citation statements)

References 10 publications

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“…This high prevalence is comparable to the results of the only similar French survey found in the literature, which was conducted among patients at a similar outpatient clinic 10 years ago in the southern city of Avignon. The authors estimated the prevalence of psychiatric disorders at 27% and indicated a prevalence of 12.0% for major depressive disorder and 21.0% for anxiety disorder [13]. …”

Section: Discussionmentioning

confidence: 99%

Depression prevalence and primary care among vulnerable patients at a free outpatient clinic in Paris, France, in 2010: results of a cross-sectional survey

et al. 2013

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BackgroundData on the prevalence of depression and on how a depressive episode prompts the sufferer to seek primary care are not scarce, but the available evidence on the prevalence of depression among immigrants and poor people who frequent general practice facilities is scarce. The Baudelaire Outpatient Clinic at the Saint-Antoine Hospital in Paris provides free medical and social assistance to the poor and/or uninsured. The goal of our study was to estimate the prevalence of depression among these outpatients, to characterize this depressed population, and to analyze its demand for primary care for depressive episodes.MethodsFrom September to December 2010, we conducted a cross-sectional, observational survey among users of the Baudelaire Outpatient Clinic. French-speaking patients attending the clinic between September 15 and December 30, 2010 who agreed to answer a questionnaire administered face-to-face before their consultation were included in the study. The chi-squared test (or Fisher’s exact test for small samples) was used for the comparisons of proportions. Logistic regression models were estimated, along with the odds ratios (OR) and their 95% confidence intervals (95% CIs), for the multivariate analysis of factors associated with depression and healthcare-seeking. Models were estimated separately for men and women, since sex was an interaction factor. The statistical analyses were performed using Stata v. 10 software (StataCorp LP, College Station, Texas, USA).ResultsOf the 250 patients included (mean age: 45 years), 52.0% were men and 52.4% were immigrants. Close to 40% of them reported having no supplemental health insurance. The estimated prevalence of depression in this population was 56.7%. Depression was more prevalent among the women, immigrants, and people from the poorer socioeconomic groups. Only half of these depressed patients, mostly women, reported having discussed their depression with a physician. French nationality and complete health insurance coverage were associated with more-frequent healthcare-seeking. Few patients reported having been asked about their morale by the physician they consulted, and almost 80% would have liked to be asked about this more often.ConclusionDepression is a real public health problem, particularly among people from disadvantaged backgrounds, and should be included in their overall management.

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Section: Discussionmentioning

confidence: 99%

Depression prevalence and primary care among vulnerable patients at a free outpatient clinic in Paris, France, in 2010: results of a cross-sectional survey

et al. 2013

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“…These two molecules target dermatological diseases such as mycoses. According to several authors [27,28], dermatological conditions are the most common health problem in precarious populations, especially in homeless people, because of di cult living conditions (poor hygiene, overcrowding, nutritional de ciencies, unfavorable working conditions etc.). Strengthening these observations, over-prescription of antifungals has been largely reported in precarious individuals, especially in children [28].…”

Section: Discussionmentioning

confidence: 99%

High and daily exposure to precariousness negatively impacts the prescriptions of general practitioners to precarious populations: an observational pharmaco-epidemiological study investigating inequalities in access to health care in France

Birault

Bonheur

Clodion

et al. 2021

Preprint

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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.

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Les enfants en situation de vulnérabilité sociale: expérience au sein d'une consultation médicosociale d'un centre hospitalier universitaire

Scanvion

Pascal

Picherot

et al. 2007

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Étude prospective des caractéristiques médicopsychosociales de 350 patients ayant consulté une permanence d’accès aux soins de santé en 2002

Cited by 8 publications

References 10 publications

Depression prevalence and primary care among vulnerable patients at a free outpatient clinic in Paris, France, in 2010: results of a cross-sectional survey

Depression prevalence and primary care among vulnerable patients at a free outpatient clinic in Paris, France, in 2010: results of a cross-sectional survey

High and daily exposure to precariousness negatively impacts the prescriptions of general practitioners to precarious populations: an observational pharmaco-epidemiological study investigating inequalities in access to health care in France

Les enfants en situation de vulnérabilité sociale: expérience au sein d'une consultation médicosociale d'un centre hospitalier universitaire

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