De Oliveira Annie, Chavannes Barbara, Steinecker Magali, Denantes Mady, Chastang Julie, Ibanez Gladys
Department of General Practice, Medicine Sorbonne University, Paris, France.
Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, (IPLESP), F75012, Paris, France.
Fam Med Community Health. 2019 Nov 3;7(4):e000044. doi: 10.1136/fmch-2018-000044. eCollection 2019.
Several studies have shown the role of the primary care system in access to care and in reducing social inequalities in health. The objective of this study was to describe the practices of general practitioners (GPs) in taking into account the social environment of their patient, and the ways they adapted to social difficulties.
Qualitative study comprising interviews and focus groups.
French primary care settings.
Twenty semistructured interviews and two focus groups were conducted with 33 GPs. Sessions were audio recorded, transcribed verbatim and analysed using thematic analysis. The reporting of findings was guided by consolidated criteria for reporting qualitative research.
This study identified adaptations at three levels: in the individual management of patients (alert system, full involvement in prevention, better communication, prioritised additional examinations, financial facilities, help in administrative tasks), in the collective management of patients in an office (consultation without appointment, pay-for-performance indicators, medical staffs, multidisciplinary protocols, medical practice in group, medical student), and in the community management (patients description, cooperation with associations, public health sector and politics).
In France, GPs can take into account the social determinants of health in practice through simple or more complex actions.
多项研究表明初级保健系统在获得医疗服务以及减少健康方面的社会不平等现象中所起的作用。本研究的目的是描述全科医生（GPs）在考虑患者社会环境方面的做法，以及他们适应社会困难的方式。
包括访谈和焦点小组的定性研究。
法国初级保健机构。
对33名全科医生进行了20次半结构化访谈和2次焦点小组访谈。访谈进行了录音，逐字转录，并采用主题分析法进行分析。研究结果的报告遵循定性研究报告的统一标准。
本研究确定了三个层面的适应措施：在患者的个体管理方面（警报系统、全面参与预防、更好的沟通、优先进行额外检查、财务便利、行政任务协助）；在诊所患者的集体管理方面（无需预约的咨询、按绩效付费指标、医务人员、多学科协议、团队医疗实践、医学生）；以及在社区管理方面（患者描述、与协会、公共卫生部门和政治的合作）。
在法国，全科医生可以通过简单或更复杂的行动在实践中考虑健康的社会决定因素。
