[The general practitioner in old age homes : an incongruous actor ? Study in old-age homes in a deprived area].

CONTEXT: Residential facilities for dependent elderly people have difficulties ensuring medical follow-up of their residents by general practitioners. The barriers to medical visits are well-known. Seine-Saint-Denis is particularly affected by the medical demography crisis.

OBJECTIVES: To describe the organization of visits by general practitioners in residential facilities for dependent elderly people in Seine-Saint-Denis. To assess the influence of the institutions' status on this organization.

METHOD: Quantitative descriptive cross-sectional study of 65 facilities in Seine Saint-Denis. A questionnaire drawn from the literature on known barriers to medical visits was used.

RESULTS: Fifty institutions (76.9%) contributed. Most visits (88.0%) took place in patients' rooms. When the practitioner arrived, the patient was present at the site in 80.0% of the facilities, especially when they were private and associative (p = 0.01). The doctor was accompanied by a staff member in 30.0% of the facilities, especially when they were for-profit (p = 0.02). Exchanges between general practitioners and the staff were sporadic and unorganized. All in all, the public facilities seemed to be less well-organized to receive general practitioners.

DISCUSSION: Residential facilities for the elderly do not seem to have implemented specific organization for visits by general practitioners, who are not integrated in the staff.

CONCLUSION: Experiments with doctors gainfully employed in institutions could be carried out, following the example of several foreign countries.