[Chronic diseases and precarity: obstacles to management and recommendations]

A study was conducted in the Lorraine region concerning the difficulties encountered in the management of chronic diseases in patients in a situation of precarity based on interviews of the patients concerned and general practitioners. Numerous difficulties as well as several facilitating factors were identified. The elements reported by patients and doctors frequently converged: the importance of living conditions, the frequently pejorative attitudes of doctors, administrative complexities. The doctor-patient relationship is the cornerstone of facilitating factors. Patients attach considerable importance to the relationship of confidence developed with their attending physician. They want their doctor to use simple words and avoid making them feel guilty, allowing them to enter into a real healthcare partnership in which they can actively participate in decisions concerning them. On the basis ofthesefindings, thestudy formulated recommendations for improvement of management, essentially concerning administrative measures of social protection and access to care.