{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:53:38Z","timestamp":1760151218299,"version":"build-2065373602"},"reference-count":55,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T00:00:00Z","timestamp":1646265600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>(1) Background: Precarious patients are more difficult to care for due to low literacy rates and poor adherence to treatment and hospitalization. These difficulties have detrimental effects on general practitioners (GPs), deteriorating medical communication, advice, diagnoses, and drug prescriptions. To better understand how precariousness affects primary care, we tested whether, among GPs, exposure to high precariousness prevalence more severely impacts drug prescriptions to precarious and non-precarious populations compared to low precariousness prevalence. Materials and methods: This pharmaco-epidemiological study, using linear regression analyses, compared the defined daily dose of 20 drugs prescribed by GPs to precarious and non-precarious patients in four French regions with low and high precariousness prevalence in 2015. (2) Findings: Exposure to high precariousness prevalence significantly impacted the prescriptions of nine medications to precarious patients and two medications to non-precarious patients, and distributed into three interaction patterns. (3) Interpretation: The selective over-prescription of drugs with easy intake modalities to precarious patients probably reflects GPs\u2019 attempts to compensate for poor patient compliance. In contrast, the under-prescription of drugs targeting fungal infections in precarious populations and diabetes and cardiovascular diseases in non-precarious populations was seemingly due to a breakdown of empathy and professional exhaustion, causing medical neglect.<\/jats:p>","DOI":"10.3390\/ijerph19052962","type":"journal-article","created":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T09:24:53Z","timestamp":1646299493000},"page":"2962","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exposure to High Precariousness Prevalence Negatively Impacts Drug Prescriptions of General Practitioners to Precarious and Non-Precarious Populations: A Retrospective Pharmaco-Epidemiological Study"],"prefix":"10.3390","volume":"19","author":[{"given":"Fran\u00e7ois","family":"Birault","sequence":"first","affiliation":[{"name":"D\u00e9partement de M\u00e9decine G\u00e9n\u00e9rale, Facult\u00e9 de M\u00e9decine et de Pharmacie, Universit\u00e9 de Poitiers, F-86000 Poitiers, France"},{"name":"D\u00e9partement de M\u00e9decine G\u00e9n\u00e9rale, Maison de Sant\u00e9 Pluriprofessionnelle Universitaire des Couronneries, F-86000 Poitiers, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lakshmipriva","family":"Le Bonheur","sequence":"additional","affiliation":[{"name":"D\u00e9partement de M\u00e9decine G\u00e9n\u00e9rale, Facult\u00e9 de M\u00e9decine et de Pharmacie, Universit\u00e9 de Poitiers, F-86000 Poitiers, France"},{"name":"D\u00e9partement de M\u00e9decine G\u00e9n\u00e9rale, Maison de Sant\u00e9 Pluriprofessionnelle Universitaire des Couronneries, F-86000 Poitiers, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6779-9484","authenticated-orcid":false,"given":"Nicolas","family":"Langbour","sequence":"additional","affiliation":[{"name":"Centre Hospitalier Henri Laborit, Unit\u00e9 de Recherche Clinique Pierre Deniker, F-86021 Poitiers, France"},{"name":"Centre de Recherches sur la Cognition et l\u2019Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Universit\u00e9 de Poitiers, F-86021 Poitiers, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandivanie","family":"Clodion","sequence":"additional","affiliation":[{"name":"D\u00e9partement de M\u00e9decine G\u00e9n\u00e9rale, Maison de Sant\u00e9 Pluriprofessionnelle Universitaire des Couronneries, F-86000 Poitiers, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nematollah","family":"Jaafari","sequence":"additional","affiliation":[{"name":"Centre Hospitalier Henri Laborit, Unit\u00e9 de Recherche Clinique Pierre Deniker, F-86021 Poitiers, France"},{"name":"Centre de Recherches sur la Cognition et l\u2019Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Universit\u00e9 de Poitiers, F-86021 Poitiers, France"},{"name":"D\u00e9partement de Psychiatrie, Facult\u00e9 de M\u00e9decine et de Pharmacie, Universit\u00e9 de Poitiers, F-86000 Poitiers, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie-Christine","family":"Perault-Pochat","sequence":"additional","affiliation":[{"name":"Laboratoire de Neurosciences Exp\u00e9rimentales et Cliniques, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale (INSERM U 1084), Universit\u00e9 de Poitiers, F-86000 Poitiers, France"},{"name":"Service de Pharmacologie Clinique et Vigilances, Centre Hospitalo-Universitaire de Poitiers, F-86021 Poitiers, France"},{"name":"Centre Hospitalo-Universitaire de Poitiers, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale (INSERM CIC1402), Universit\u00e9 de Poitiers, F-86021 Poitiers, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B\u00e9rang\u00e8re","family":"Thirioux","sequence":"additional","affiliation":[{"name":"Centre Hospitalier Henri Laborit, Unit\u00e9 de Recherche Clinique Pierre Deniker, F-86021 Poitiers, France"},{"name":"Centre de Recherches sur la Cognition et l\u2019Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Universit\u00e9 de Poitiers, F-86021 Poitiers, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"302","DOI":"10.17730\/0018-7259.77.4.302","article-title":"Structural vulnerability and supplemental security income: Subtle modes of punitive governance within federal social welfare","volume":"77","author":"Lopez","year":"2018","journal-title":"Hum. Organ."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"112683","DOI":"10.1016\/j.socscimed.2019.112683","article-title":"Precarity and health: Theorizing the intersection of multiple material-need insecurities, stigma, and illness among women in the United States","volume":"245","author":"Whittle","year":"2020","journal-title":"Soc. Sci. Med."},{"key":"ref_3","unstructured":"Proctor, B.D., Semega, J.L., Kollar, M.A., and U.S. Census Bureau (2016). Current Population Reports, P60-256(RV). Income and Poverty in the United States, U.S. Government Printing Office."},{"key":"ref_4","unstructured":"Webber, D., and Callum, C. (2017). Persistent Poverty in the UK and EU: 2015 Rates of Persistent Relative Income Poverty for the UK Are Compared with Other EU Countries, Eurostat, Office for National Statistics."},{"key":"ref_5","unstructured":"(2021, May 18). La Situation D\u00e9mographique en 2015\u2014Insee R\u00e9sultats. Available online: https:\/\/www.insee.fr\/fr\/statistiques\/2851587."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Sumner, A., Ortiz-Juarez, E., and Hoy, C. (2020). Precarity and the Pandemic. COVID-19 and Poverty Incidence, Intensity, and Severity in Developing Countries, UNU-WIDER. WIDER Working Paper 77\/UNU-WIDER.","DOI":"10.35188\/UNU-WIDER\/2020\/834-4"},{"key":"ref_7","unstructured":"Marmot, M. (2021, May 18). Fair Society, Healthy Lives: The Marmot Review: Strategic Review of Health Inequalities in England Post-2010. Available online: https:\/\/www.parliament.uk\/globalassets\/documents\/fair-society-healthy-lives-full-report.pdf."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.lpm.2011.01.021","article-title":"Mortality and hospital admissions rates and diagnosis among individuals with low income and full health insurance coverage in France","volume":"40","author":"Tuppin","year":"2011","journal-title":"Presse Med."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Bernstein, S.F., Rehkopf, D., Tuljapurkar, S., and Horvitz, C.C. (2018). Poverty dynamics, poverty thresholds, and mortality. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0195734"},{"key":"ref_10","unstructured":"Allonier, C., Boisguerin, B., and Le Fur, P. (2021, September 02). UMC Beneficiaries Report More Pathologies Than the Rest of the Population. 2006\u20132008 ESPS Surveys Results. Available online: http:\/\/www.irdes.fr\/Publications\/2012\/Qes173.pdf."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.socscimed.2010.04.027","article-title":"Poverty and common mental disorders in low and middle income countries: A systematic review","volume":"71","author":"Lound","year":"2010","journal-title":"Soc. Sci. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"590","DOI":"10.5604\/12321966.1120608","article-title":"Obesity and poverty paradox in developed countries","volume":"21","author":"Wroblewska","year":"2014","journal-title":"Ann. Agric. Environ. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"672","DOI":"10.3399\/bjgp14X682009","article-title":"Should doctors record their patients\u2019 income?","volume":"64","author":"Moscrop","year":"2014","journal-title":"Br. J. Gen. Pract."},{"key":"#cr-split#-ref_14.1","unstructured":"Birault, F., Mignot, S., Caunes, N., Boutin, P., Bouquet, E., P\u00e9rault-Pochat, M.C., and Thirioux, B. (2020). The characteristics of care provided to population"},{"key":"#cr-split#-ref_14.2","unstructured":"(s) in precarious situations in 2015. A preliminary study on the Universal Health Cover in France. Int. J. Environ. Res. Public Health, 17."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2680","DOI":"10.2337\/diacare.28.11.2680","article-title":"Association among individual deprivation, glycemic control and diabetes complications: The EPICES scores","volume":"28","author":"Bihan","year":"2005","journal-title":"Diabetes Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1503\/cmaj.050584","article-title":"Inequalities in access to medical care by income in developed countries","volume":"174","author":"Masseria","year":"2006","journal-title":"CMAJ"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.jemep.2018.07.010","article-title":"Clinical public health, a model for identifying medico-social determinants of health? Ethics reflections and feedback on precariousness","volume":"6","author":"Tudrej","year":"2018","journal-title":"Ethics Med. Public Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e000044","DOI":"10.1136\/fmch-2018-000044","article-title":"How French general practitioners adapt their care to patients with social difficulties?","volume":"7","author":"Chavannes","year":"2019","journal-title":"Fam. Med. Community Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"100870","DOI":"10.1016\/j.ssmph.2021.100870","article-title":"Area-level deprivation and geographic factors influencing utilization of General Practitioner services","volume":"15","author":"Barlow","year":"2021","journal-title":"SSM Popul. Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1016\/S0140-6736(17)30402-6","article-title":"Non-communicable disease syndemics: Poverty, depression, and diabetes among low-income populations","volume":"389","author":"Mendenhall","year":"2017","journal-title":"Lancet"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e037079","DOI":"10.1136\/bmjopen-2020-037079","article-title":"GACD Multi-Morbidity Working Group. Critical review of multimorbidity outcome measures suitable for low-income and middle-income country settings: Perspectives from the Global Alliance for Chronic Diseases (GACD) researchers","volume":"10","author":"Hurst","year":"2020","journal-title":"BMJ Open"},{"key":"ref_22","unstructured":"WHO (2020). The Anatomical Therapeutic Chemical Classification System with Defined Daily Doses (ATC\/DDD), World Health Organization. Available online: https:\/\/www.has-sante.fr\/upload\/docs\/application\/pdf\/hbp_2003_recommandations.pdf."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.socscimed.2005.05.028","article-title":"Patient characteristics and inequalities in doctors\u2019 diagnostic and management strategies relating to CHD: A video-simulation experiment","volume":"62","author":"Arber","year":"2006","journal-title":"Soc. Sci. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1416","DOI":"10.1016\/j.socscimed.2011.07.031","article-title":"Do general practitioners overestimate the health of their patients with lower education?","volume":"73","author":"Delpierre","year":"2011","journal-title":"Soc. Sci. Med."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Bensing, J.M., Tromp, E., van Dulmen, S., van den Brink-Muinen, A., Verheul, W., and Schellevis, F. (2006). Shifts in doctor-patient communication between 1986 and 2002: A study of videotaped general practice consultations with hypertension patients. BMC Fam. Pract., 7.","DOI":"10.1186\/1471-2296-7-62"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1111\/j.1475-6773.2006.00638.x","article-title":"Socioeconomic and racial\/ethnic differenes in the discussion of cancer screening: \u201cBetween-\u201dversus \u201cWithin-\u201d physician differences","volume":"42","author":"Bao","year":"2007","journal-title":"Health Serv. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1467-9566.2007.01025.x","article-title":"The influence of patient and doctor gender on diagnosis coronary heart disease","volume":"30","author":"Adams","year":"2008","journal-title":"Sociol. Health Illn."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1016\/j.socscimed.2007.03.036","article-title":"Physicians\u2019 communication and perceptions of patients: Is it how they look, how they talk, or is it just the doctor?","volume":"65","author":"Street","year":"2007","journal-title":"Soc. Sci. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.pec.2004.02.011","article-title":"Socio-economic status of the patient and doctor-patient communication: Does it make a difference?","volume":"56","author":"Willems","year":"2005","journal-title":"Patient Educ. Couns."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.respe.2017.05.004","article-title":"Value of a national admistrative database to guide public decision: From the syst\u00e8me national d\u2019information interr\u00e9gimes de l\u2019Assurance Maladie (SNIIRAM) to the syst\u00e8me national des donn\u00e9es de sant\u00e9 (SNDS) in France","volume":"65","author":"Tuppin","year":"2017","journal-title":"Rev. Epid\u00e9miol. Sant\u00e9 Publique"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1146\/annurev-med-063014-123902","article-title":"Management of Benign Prostatic Hyperplasia","volume":"67","author":"Kim","year":"2016","journal-title":"Annu. Rev. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.jcjo.2016.07.013","article-title":"Glaucoma treatment trends: A review","volume":"52","author":"Conlon","year":"2017","journal-title":"Can. J. Ophtalmol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"529","DOI":"10.21037\/tau.2019.10.01","article-title":"Epidemiology and treatment modalities for the management of benign prostatic hyperplasia","volume":"8","author":"Lokeshwar","year":"2019","journal-title":"Transl. Androl. Urol."},{"key":"ref_34","first-page":"1","article-title":"Symptoms of men\u2019s lower urinary tract in Yaounde\u2019s Central Hospital: Report of 329","volume":"14","author":"Fouda","year":"2013","journal-title":"Health Sci. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1158\/1055-9965.EPI-12-0497","article-title":"Limited PSA testing in indigent men in South Texas: An appropriate care or missing a prevention opportunity?","volume":"21","author":"Liang","year":"2012","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2381","DOI":"10.1001\/archinte.166.21.2381","article-title":"Prevalence of lower urinary tract symptoms and effect on quality of life in a racially and ethnically diverse random sample: The Boston Area Community Health (BACH) Survey","volume":"166","author":"Kupelian","year":"2006","journal-title":"Arch. Intern. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.amjmed.2008.05.021","article-title":"Epidemiology of benign prostatic hyperplasia and comorbidities in racial and ethnic minority populations","volume":"121","author":"Hoke","year":"2008","journal-title":"Am. J. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/S0929-6646(08)60118-7","article-title":"Prevalence of lower urinay tract symptoms in male aborigines and non-aborigines in eastern Taiwan","volume":"107","author":"Kuo","year":"2008","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2183","DOI":"10.1016\/S0140-6736(17)31469-1","article-title":"Glaucoma","volume":"390","author":"Jonas","year":"2017","journal-title":"Lancet"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/S0140-6736(89)90076-7","article-title":"World-wide antibotic resistance in methicillin-resistant Staphylococcus aureus","volume":"1","author":"Maple","year":"1989","journal-title":"Lancet"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1080\/00981389.2019.1645795","article-title":"Social determinants of health: The how, who, and where screenings are occurring: A systematic review","volume":"58","year":"2019","journal-title":"Soc. Work Health Care"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1111\/j.1750-3639.1997.tb01078.x","article-title":"Fungal infections","volume":"7","author":"Chimelli","year":"1997","journal-title":"Brain Pathol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.pop.2015.08.004","article-title":"Superficial fungal infections","volume":"42","author":"Kaushik","year":"2015","journal-title":"Prim. Care"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"763","DOI":"10.3389\/fpsyg.2016.00763","article-title":"Empathy is a protective factor of burnout in physicians: New neuro-phenomenological hypotheses regarding empathy and sympathy in care relationship","volume":"7","author":"Thirioux","year":"2016","journal-title":"Front. Psychol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1177\/1062860612464731","article-title":"Empathy and health care quality","volume":"28","author":"Hojat","year":"2013","journal-title":"Am. J. Med. Qual."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1002\/job.4030020205","article-title":"The measurement of experienced burnout","volume":"2","author":"Maslach","year":"1981","journal-title":"J. Organ. Behav."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"358","DOI":"10.7326\/0003-4819-136-5-200203050-00008","article-title":"Burnout and self-reported patient care in an internal medicine residency program","volume":"136","author":"Shanafelt","year":"2002","journal-title":"Ann. Intern. Med."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Reader, T.W., and Gillepsie, A. (2013). Patient neglect in healthcare institutions: A systematic review and conceptual model. BMC Health Serv. Res., 13.","DOI":"10.1186\/1472-6963-13-156"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e145","DOI":"10.1017\/S1463423619000793","article-title":"Cross-sectional study of the association between empathy and burnout and drug prescribing in primary care","volume":"20","author":"Yugero","year":"2019","journal-title":"Prim. Health Care Res. Dev."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Yugero, O., Esquerda, M., Marsal, J.R., and Soler-Gonzales, J. (2015). Association between sick leave prescribing practices and physician burnout and empathy. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0133379"},{"key":"ref_51","first-page":"336","article-title":"Socioeconomic inequality and health in Mexico","volume":"53","year":"2015","journal-title":"Rev. Med. Inst. Mex. Seguro"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1136\/jech.2008.078923","article-title":"Social inequalities in mortality by cause among men and women in France","volume":"63","author":"Chastang","year":"2009","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2517","DOI":"10.1007\/s11606-020-06070-z","article-title":"Changes in mortality in top 10 causes of death from 2011 to J","volume":"36","author":"Rana","year":"2021","journal-title":"Gen. Intern. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1037\/0022-3514.44.1.113","article-title":"Measuring individual differences in empathy: Evidence for a multidimensional approach","volume":"44","author":"Davis","year":"1983","journal-title":"J. Pers. Soc. Psychol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/5\/2962\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:31:26Z","timestamp":1760135486000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/5\/2962"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,3]]},"references-count":55,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["ijerph19052962"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19052962","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2022,3,3]]}}}