[The general practitioner in nursing homes : an incongruous actor ? Study in nursing homes in a deprived area]

Residential facilities for dependent elderly people have difficulties ensuring medical follow-up of their residents by general practitioners. The barriers to medical visits are well-known. Seine-Saint-Denis is particularly affected by the medical demography crisis.

To describe the organization of visits by general practitioners in residential facilities for dependent elderly people in Seine-Saint-Denis. To assess the influence of the institutions' status on this organization.

Quantitative descriptive cross-sectional study of 65 facilities in Seine Saint-Denis. A questionnaire drawn from the literature on known barriers to medical visits was used.

Fifty institutions (76.9%) contributed. Most visits (88.0%) took place in patients' rooms. When the practitioner arrived, the patient was present at the site in 80.0% of the facilities, especially when they were private and associative (p = 0.01). The doctor was accompanied by a staff member in 30.0% of the facilities, especially when they were for-profit (p = 0.02). Exchanges between general practitioners and the staff were sporadic and unorganized. All in all, the public facilities seemed to be less well-organized to receive general practitioners.

Residential facilities for the elderly do not seem to have implemented specific organization for visits by general practitioners, who are not integrated in the staff.

Experiments with doctors gainfully employed in institutions could be carried out, following the example of several foreign countries.