Accès aux soins dans l’Ouest Guyanais : étude des causes de rupture thérapeutique chez les patients précaires atteints de maladie chronique
Notice bibliographique
Résumé
Context: The lack of doctors and the precariousness of the Guyanese population often lead patients suffering from chronic diseases to renounce to healthcare, causing several individual and collective complications. The main objective of this study is to understand and explore the different causes of treatment interruption among precarious patients with a chronic disease in West French Guiana. Material and Method: A qualitative survey, using semi-structured interviews, has been achieved from September to October 2021 at the permanence of access to healthcare of the West French Guiana hospital. The interviewees were patients with a chronic disease who had interrupted their medical follow-up for more than 3 months. Results: Of the 16 interviewees (aged between 42 and 88), 12 were Surinamese. Others were Haitan, Brazilian, Guyanese and stateless. 12 patients had high blood pressure, 2 had diabetes, 4 had both pathology and one had diabetes and lymphoma. The median duration of follow-up interruption was 7 months. One third of the respondents reported they did not feel their illness on a daily basis, while it was hard to live with for another third. The survey highlighted that some patients had a poor understanding of the treatment regimen, or discontinued treatment due to adverse effects, except for a quarter of the interviewees who feel positive effects of the treatment. Lack of knowledge of the French health care system and the failings of the family caregiver could also be other obstacles to treatment adherence. For a majority of respondents, the complexity of the administrative procedures required to obtain social coverage was responsible for the therapeutic disruption. The Franco-Surinamese border was both a help and a limit in access to care. Financial difficulties, geographical distance and lack of transportation were also emphasized. In response to these obstacles, alternative strategies such as the use of traditional medicine and diets have been employed. Half of the patients spontaneously requested support and care. Conclusion: Therapeutic adherence in a precarious environment depends on multiple factors, related to the chronic disease and the Guyanese territory. The results of this study highlight the importance of therapeutic education programs, and the need for improvements in access to care for the most vulnerable people in order to reduce the impact of chronic diseases in West French Guiana.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,007 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,006 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,002 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».