Département de Médecine Générale, Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France.
Département de Médecine Générale, Maison de Santé Pluriprofessionnelle Universitaire des Couronneries, F-86000 Poitiers, France.
Int J Environ Res Public Health. 2022 Mar 3;19(5):2962. doi: 10.3390/ijerph19052962.
(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.
(1) 背景：由于文化程度低，治疗和住院的依从性差，不稳定患者更难护理。这些困难对全科医生（GP）有不利影响，使医疗沟通、建议、诊断和药物处方恶化。为了更好地了解不稳定状况如何影响初级保健，我们测试了在全科医生中，与低不稳定流行率相比，高不稳定流行率的暴露是否更严重地影响了不稳定和非不稳定人群的药物处方。材料和方法：本项药物流行病学研究使用线性回归分析，比较了 2015 年法国四个地区低和高不稳定流行率下全科医生为不稳定和非不稳定患者开的 20 种药物的日剂量。(2) 结果：高不稳定流行率的暴露显著影响了 9 种药物对不稳定患者和 2 种药物对非不稳定患者的处方，并分为三种相互作用模式。(3) 解释：为不稳定患者开容易服用方式的药物的选择性过度处方可能反映了全科医生试图弥补患者依从性差的问题。相比之下，不稳定人群中针对真菌感染和非不稳定人群中针对糖尿病和心血管疾病的药物处方不足，似乎是由于同理心和职业倦怠的破裂，导致医疗忽视。
