A French classification to describe medical deserts: a multi-professional approach based on the first contact with the healthcare system.

BACKGROUND: Increasing inequalities in accessibility to primary care has generated medical deserts. Identifying them is key to target the geographic areas where action is needed. An extensive definition of primary care has been promoted by the World Health Organization: a first level of contact with the health system, which involves the co-presence of different categories of health professionals alongside the general practitioner for the diagnosis and treatment of patients. Previous analyses have focused mainly on a single type of provider while this study proposes an integrated approach including various ones to define medical deserts in primary care. METHOD: Our empirical approach focuses on the first point of contact with the health system: general practitioners, proximity primary care providers (nurses, physiotherapists, pharmacies, laboratories, and radiologists), and emergency services. A multiple analysis approach was performed, to classify French municipalities using the information on the evolution and needs of health care accessibility, combining a principal component analysis and a hierarchical ascending classification. RESULTS: Two clusters of medical deserts were identified with low accessibility to all healthcare professionals, socio-economic disadvantages, and a decrease in care supply. In other clusters, accessibility difficulties only concern a part of the health supply considered, which raises concern for the efficiency of primary care for optimal healthcare pathways. Even for clusters with better accessibility, issues were identified, such as a decrease and high needs of health care supply, revealing potential future difficulties. CONCLUSION: This work proposes a multi-professional and multi-dimensional approach to medical deserts based mainly on an extensive definition of primary care that shows the relevance of the co-presence of various healthcare professionals. The classification also makes it possible to identify areas with future problems of accessibility and its potential consequences. This framework could be easily applied to other countries according to their available data and their health systems' specificities.

Has the diffusion of primary care teams in France improved attraction and retention of general practitioners in rural areas?

Many countries, including France, are facing the old and persistent problem of geographical inequalities of their health human resources, in particular general practitioners (GPs). This situation leads, among other things, to underserved areas, which could result in a lower level of primary health care accessibility. Since the mid-2000s in France, several policies were implemented to provide financial as well as other incentives to support the development of multi-professional group practices, Primary Care Teams (PCTs), in order to attract and retain GPs in underserved areas. This study aims to measure the impact of PCTs settlement on the evolution of GP density in rural areas. To this end, we compare the evolution of GP density between rural areas with PCTs and similar rural areas without PCTs, before (2004-2008) and after (2008-2012) the development of PCTs facilities. The results show that PCTs are mainly located in underserved areas and suggest that they could attract and retain GPs there. Those results should be of interest to countries facing relatively similar geographical inequalities issues and that are also experimenting with multi-professional group practices.

["Medical deserts" and accessibility to care: what are we talking about?] / « Déserts médicaux ¼ et accessibilité aux soins : de quoi parle-t-on ?

In France, accessibility to primary health care seems to be threatened by the existence or the emergence of underserved areas often called "medical deserts". These areas are characterized by several parameters such as a poor number of health professionals, remoteness or high needs of care. We discuss here different methods to measure primary health care accessibility or imbalance between health care providers and needs. Thus, we aim to show the confusion generated by the concept of "medical deserts" and the stakes for public authorities to define measures to attract and retain general practitioners in such areas.

Critical urban areas, deprived areas and neighbourhood effects on health in France.

Since the 1980s, different French governments have formulated public policies aimed at taking into account the specific problems of deprived neighbourhoods. The aim of this paper is to determinate the existence of a neighbourhood effect on health and to discuss the implementation of a geographical index of deprived areas in France. Using the National Health Survey of 2002-2003 and 1999 French census data, we attempt to measure the individual and collective determinants of Self-Reported Health Status (SRH). By using a principal component analysis of aggregated census data, we obtain three synthetic factors: "economic and social condition", "residential stability" and "generational", and show that these contextual factors are correlated with individual SRH. Our research shows that health inequalities cannot be tackled by using only the Critical Urban Area criterion (the fact of living in a CUA or not) because some inequalities remain ignored and thus, hidden. We suggest a methodology to build a new health deprivation index allowing to better target health inequalities.