[The free delivery of drugs during hospital consultations].
BACKGROUND
In France, the access to treatment has become a priority and a right. Hence, the supply of care has been reorganised in order to improve the management of the health scourges for all the patients, whether they can pay for what they need or not. The free delivery of drugs (FDD) is part of the services offered by the public hospitals for the low income patients or those who do not yet benefit from social security coverage. As such, it is inscribed within the context of the right to treatment and is a corner stone to a new mission of the public hospital services and care networks.


METHODS
The polyclinic of the Max Fourestier hospital is one of hospitals in the Paris area that supplies medical and surgical consultations to the population and provides drugs free of charge. From April 1, 1999 to the end of June 2000, all the FDD were studied for all the non-hospitalised outpatients who came to the consultations with a prescription for drugs, which could not be supplied in a pharmacy because of lack of revenues or social security coverage.


RESULTS
The diseases encountered in the context of FDD were the same as those of the general population. No specificity was revealed in the prescriptions related to vulnerability. If it were necessary, this would confirm the fact that the management of persons in difficulty should be integrated in the provisions of common rights. The treatments concerned were essential, and for some persons life saving, and justifying the interest of FDD without which the health of these individuals would rapidly decline. Furthermore, this study shows the need for careful management of FDD in order to avoid the anarchical and uncontrolled delivery of several prescriptions, source of deleterious drug interactions and iatrogenia. This is the reason for the recommendation to all the staff delivering free drugs that they systematically ask the patients to meet a referring physician and contact the hospital pharmacist when necessary.


CONCLUSIONS
The FDD request is an ideal occasion for a physician to meet the patient and, because of the professional secrecy, to learn more of the patient's life style, and reveal, other than the diseases, the patients risk factors or elements of vulnerability that interact with the general state of health. The access to rights, on the occasion of FDD, is a fundamental public health strategy, since it provides the patient with access to preventive and primary care health measures. This is why we propose that FDD, other than the medical consultation, become systematically coupled with a consultation with a social care worker, to permit the rapid return of the patients to their common rights.


CONCLUSIONS
Free drug delivery should not be conceived as a traditional pharmaceutical delivery, it should be the pretext for the reintegration of persons to their social rights and with a strategy of improved medical care. Organised in this manner, FDD is a precious tool for access to care and prevention, but also to the construction of a social relationship.
D003266:Continuity of Patient Care; D019033:Delivery of Health Care, Integrated; D016527:Drug Costs / Q000706:statistics & numerical data*; D004347:Drug Interactions; D011307:Drug Prescriptions / Q000145:classification / Q000191:economics*; D017723:Drug Utilization Review; D005260:Female; D006297:Health Services Accessibility / Q000191:economics; D006302:Health Services Research; D006779:Hospitals, Public / Q000191:economics*; D006801:Humans; D008019:Life Style; D008297:Male; D008489:Medical Indigency / Q000191:economics; D020380:Needs Assessment; D010044:Outpatient Clinics, Hospital; D010297:Paris; D010607:Pharmacy Service, Hospital / Q000191:economics*; D010817:Physician-Patient Relations; D011203:Poverty / Q000191:economics; D012017:Referral and Consultation / Q000191:economics*; D012307:Risk Factors; D012943:Social Security / Q000191:economics; D012947:Social Work; D035862:Vulnerable Populations / Q000706:statistics & numerical data