Accès aux soins dans l’Ouest Guyanais : étude des causes de rupture thérapeutique chez les patients précaires atteints de maladie chronique
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.006 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".