Social vulnerability and unmet preventive care needs in outpatients of two French public hospitals.
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.


CONCLUSIONS
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.
Pascal
Jean
J
Pôle d'Information Médicale, d'Evaluation et de Santé Publique, CHU de Nantes, Hôpital Saint Jacques, 44093 Nantes Cedex 1, France. jean.pascal@chu-nantes.fr
Abbey-Huguenin
Hélène
H
Leux
Christophe
C
Lombrail
Pierre
P
Lert
France
F
D000328:Adult; D000553:Ambulatory Care; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008875:Middle Aged; D011314:Preventive Health Services; D012189:Retrospective Studies; D012923:Social Class; D035862:Vulnerable Populations; D055815:Young Adult