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Birault F, Le Bonheur L, Langbour N, Clodion S, Jaafari N, Perault-Pochat MC, Thirioux B. Exposure to High Precariousness Prevalence Negatively Impacts Drug Prescriptions of General Practitioners to Precarious and Non-Precarious Populations: A Retrospective Pharmaco-Epidemiological Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052962. [PMID: 35270655 PMCID: PMC8910740 DOI: 10.3390/ijerph19052962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 12/10/2022]
Abstract
(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.
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Affiliation(s)
- François Birault
- 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;
- Correspondence: ; Tel.: +33-549-451-111; Fax: +33-549-455-041
| | - Lakshmipriva Le Bonheur
- 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;
| | - Nicolas Langbour
- Centre Hospitalier Henri Laborit, Unité de Recherche Clinique Pierre Deniker, F-86021 Poitiers, France; (N.L.); (N.J.); (B.T.)
- Centre de Recherches sur la Cognition et l’Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Université de Poitiers, F-86021 Poitiers, France
| | - Sandivanie Clodion
- Département de Médecine Générale, Maison de Santé Pluriprofessionnelle Universitaire des Couronneries, F-86000 Poitiers, France;
| | - Nematollah Jaafari
- Centre Hospitalier Henri Laborit, Unité de Recherche Clinique Pierre Deniker, F-86021 Poitiers, France; (N.L.); (N.J.); (B.T.)
- Centre de Recherches sur la Cognition et l’Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Université de Poitiers, F-86021 Poitiers, France
- Département de Psychiatrie, Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France
| | - Marie-Christine Perault-Pochat
- Laboratoire de Neurosciences Expérimentales et Cliniques, Institut National de la Santé et de la Recherche Médicale (INSERM U 1084), Université de Poitiers, F-86000 Poitiers, France;
- Service de Pharmacologie Clinique et Vigilances, Centre Hospitalo-Universitaire de Poitiers, F-86021 Poitiers, France
- Centre Hospitalo-Universitaire de Poitiers, Institut National de la Santé et de la Recherche Médicale (INSERM CIC1402), Université de Poitiers, F-86021 Poitiers, France
| | - Bérangère Thirioux
- Centre Hospitalier Henri Laborit, Unité de Recherche Clinique Pierre Deniker, F-86021 Poitiers, France; (N.L.); (N.J.); (B.T.)
- Centre de Recherches sur la Cognition et l’Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Université de Poitiers, F-86021 Poitiers, France
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Robertson-Preidler J, Biller-Andorno N, Johnson TJ. What is appropriate care? An integrative review of emerging themes in the literature. BMC Health Serv Res 2017; 17:452. [PMID: 28666438 PMCID: PMC5493089 DOI: 10.1186/s12913-017-2357-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 06/06/2017] [Indexed: 01/16/2023] Open
Abstract
Background Health care improvement efforts should be aligned in order to make a meaningful impact on health systems. Appropriate care delivery could be a unifying goal to help coordinate efforts to improve health outcomes and ensure system sustainability. A more complete understanding of how appropriate care is currently conceived in research and clinical practice could help inform a more integrated and holistic concept of appropriate care that could guide health care policy and delivery practices. We examined the current understanding of appropriate care by identifying its use and definitions in recently published literature. Methods An integrated review of the practices, goals and perspectives of appropriate care in English language peer-reviewed articles published from 2011 to 2016. Inductive content analysis was used to describe emerging themes of appropriate care in articles meeting inclusion criteria. Results This integrative review included empirical studies, reviews, and commentaries with various health care settings, cultural contexts, and perspectives. Conceptualizations of appropriate care varied, however most descriptions fell into five main categories: evidence-based care, clinical expertise, patient-centeredness, resource use, and equity. These categories were often used in combination, indicating an integrated understanding of appropriate care. Conclusions An understanding of how appropriate care is conceptualized in research and policy can help inform an integrated approach to appropriate care delivery in policy and practice according to the relevant priorities and circumstances.
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Affiliation(s)
- Joelle Robertson-Preidler
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006, Zürich, Switzerland.
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006, Zürich, Switzerland
| | - Tricia J Johnson
- Department of Health Systems Management, Rush University, 1700 W. Van Buren Street, Suite 126B, Chicago, IL, 60612, USA
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Harmon BE, Little MA, Woekel ED, Ettienne R, Long CR, Wilkens LR, Le Marchand L, Henderson BE, Kolonel LN, Maskarinec G. Ethnic differences and predictors of colonoscopy, prostate-specific antigen, and mammography screening participation in the multiethnic cohort. Cancer Epidemiol 2014; 38:162-7. [PMID: 24667037 DOI: 10.1016/j.canep.2014.02.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/12/2014] [Accepted: 02/17/2014] [Indexed: 12/15/2022]
Abstract
PURPOSE Given the relation between screening and improved cancer outcomes and the persistence of ethnic disparities in cancer mortality, we explored ethnic differences in colonoscopy, prostate-specific antigen (PSA), and mammography screening in the Multiethnic Cohort Study. METHODS Logistic regression was applied to examine the influence of ethnicity as well as demographics, lifestyle factors, comorbidities, family history of cancer, and previous screening history on self-reported screening participation collected in 1999-2002. RESULTS The analysis included 140,398 participants who identified as white, African American, Native Hawaiian, Japanese American, US born-Latino, or Mexican born-Latino. The screening prevalences overall were mammography: 88% of women, PSA: 45% of men, and colonoscopy: 35% of men and women. All minority groups reported 10-40% lower screening utilization than whites, but Mexican-born Latinos and Native Hawaiian were lowest. Men were nearly twice as likely to have a colonoscopy (OR=1.94, 95% CI=1.89-1.99) as women. A personal screening history, presence of comorbidities, and family history of cancer predicted higher screening utilization across modalities, but to different degrees across ethnic groups. CONCLUSIONS This study confirms previously reported sex differences in colorectal cancer screening and ethnic disparities in screening participation. The findings suggest it may be useful to include personal screening history and family history of cancer into counseling patients about screening participation.
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Affiliation(s)
- Brook E Harmon
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA.
| | - Melissa A Little
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
| | - Erica D Woekel
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
| | - Reynolette Ettienne
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
| | - Camonia R Long
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
| | - Lynne R Wilkens
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
| | - Loic Le Marchand
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
| | - Brian E Henderson
- University of Southern California, Health Sciences Campus, NRT Lg 1502, Los Angeles, CA 90089, USA
| | - Laurence N Kolonel
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
| | - Gertraud Maskarinec
- University of Hawaii Cancer Center, 701 Ilalo Street, Suite 500, Honolulu, HI 96822, USA
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