The European Journal of Public Health Advance Access originally published online on March 23, 2009
The European Journal of Public Health 2009 19(4):403-411; doi:10.1093/eurpub/ckp033
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Social Determinants |
Social vulnerability and unmet preventive care needs in outpatients of two French public hospitals
Jean Pascal1, Hélène Abbey-Huguenin1, Christophe Leux1, Pierre Lombrail1 and France Lert2
1 Pôle d’Information Médicale, d’Evaluation et de Santé Publique, CHU de Nantes, Hôpital Saint Jacques, 85 rue Saint Jacques, 44093 Nantes Cedex 1, France
2 INSERM U 687, Santé publique et épidémiologie des déterminants professionnels et sociaux de la santé, Hôpital Paul Brousse – Bâtiment 15/16 – 16 avenue Paul Vaillant Couturier – 94 807 Villejuif, France
Correspondence: Jean Pascal, CHU Nantes, Hôpital Saint Jacques, PIMESP, 85, rue Saint Jacques, 44093 Nantes Cedex 1, France, tel: +33 2 40 84 69 25, fax: +33 2 40 84 69 21, e-mail: jean.pascal{at}chu-nantes.fr
Received June 2, 2008 , accepted February 17, 2009
Background: Outpatients attending consultations at public hospitals may have unmet needs for preventive medical care. This study aimed to identify and assess the association between these needs, social vulnerability and mode of healthcare use. Methods: In a multicentre epidemiological study, a group of socially vulnerable outpatients, was compared with a non-vulnerable group in a sample of 1316 outpatients selected in hospital consultations, using a validated tool for detection of social vulnerability. Before the patient was seen by medical staff, investigators collected data on social characteristics, healthcare use and preventive medical care received (interventions, advice). Results: More than 75% of outpatients stated that they were regularly followed by a physician, usually a general practitioner, but fewer vulnerable than non-vulnerable outpatients were followed (77% vs. 89%, P < 10–3). For the majority of preventive interventions (vaccinations, screening for cardiovascular risk factors, gynaecological cancers), vulnerable outpatients presented a more marked shortage than non-vulnerable patients, but there was an overall shortage in both groups. When recommended preventive interventions had not been delivered, they had rarely been offered in either group. After adjustment for mode of healthcare use, the differences in preventive care received persisted to the disadvantage of vulnerable outpatients with regard to technical preventive interventions, but there was no difference between the two groups regarding advice received to reduce risk behaviours. Conclusion: Unmet needs for preventive care primarily resulted from social inequalities in secondary access to such care. It may be necessary to set up specific interventions targeting vulnerable patients within hospital consultations.
Keywords: health inequalities, prevention, social vulnerability, healthcare use