[Difficulties in the management of precarious patients and precarious migrants]

General practitioners encounter difficulties in the management of patients in precarious situations. In order to identify and understand these difficulties, a survey combining both quantitative et qualitative approaches was conducted among general practitioners of the Meurthe-et-Moselle department.

Quantitative data were collected by self-administered questionnaires sent to all 856 general practitioners and 28 general practitioners grouped by geographic sector participated in 6 focus groups.

Among the 46.5% of respondents, 92.5% doctors declared that they encountered difficulties in the management of precarious patients. 87.5% declared that they had an average or insufficient knowledge of the existing medical social organizations on their territory and two-thirds were interested in specific training. Analysis of the interviews showed that experience facilitates multidisciplinary networking, a good relationship with patients and ultimately their monitoring. Financial access to care is a major obstacle, which doctors consider to be a political issue. Ideas for improvement were proposed in response to the obstacles related to the characteristics of the medical consultation itself. Confirming the results of the questionnaire survey, training appeared to be essential to identify vulnerability and facilitate the doctor-patient relationship.

We showed that the difficulties experienced by physicians contributes to socio-cultural inequalities in access to health care. Patient support, an enhanced self image and social ties were identified as major determinants of access to health. The development of training of physicians and multidisciplinary structures should be encouraged.