General Practice (GP) is the entry point to the healthcare system. In the city of XXX (Paris area), this access is notably provided by four Municipal Health Centers (CMS). These centers fight against territorial health inequalities in a context of scarce medical provision, while the city's economically disadvantaged population has significant health needs. Studying the factors favoring or limiting the health-related mobility of patients consulting in GP in these centers would allow identifying levers to facilitate access.To investigate the socio-demographic factors associated with the mobility of patients consulting in GP at the XXX CMS.A retrospective observational cross-sectional study was conducted using administrative data extracted from the practice management software. The walking distance between the patients' homes and the reference CMS was used as the primary outcome. Associations between socio-demographic data and this distance were calculated using a multilevel mixed model to account for a possible ecological effect of the patients' social environment using the Fdep social deprivation index.13,072 patients from 43,116 GP consultations were analyzed. After adjustment, adulthood (age between 26 and 60), male gender, and means-tested health insurance were associated with a greater walking distance. CMS located at crossroads of human mobility and transport routes were associated with a greater distance traveled compared to isolated ones.Several confounding factors, particularly related to health status, which could explain reduced mobility, could not be taken into consideration as this study is limited to administrative data. This study allows outlining several profiles of patients consulting in the XXX CMS according to their mobility.Examining mobility associated with GP care allows characterizing the territorial footprint of healthcare sites and the spatial practices of their users. Identifying the least mobile individuals, who are possibly excluded from care, allows implementing measures to maintain this link as well as outreach actions.

Ensuring equitable access to care for people with disabilities is a national priority in France, reinforced by the 2005 law mandating accessibility for all public facilities. In a context marked by demographic growth, population ageing and an increasing number of people living with disabilities, the Territorial Professional Health Communities (CPTS), created in 2016, aim to improve access to care across communities. Within the CPTS of Saintonge Romane, accessibility of general practices and pharmacies remains crucial to support autonomy and reduce disparities. This study explored how healthcare professionals address accessibility and how collaborative practices contribute to improving patient pathways.To assess the current state of accessibility in general practices and pharmacies for people with disabilities within the Saintonge Romane CPTS, using a combined quantitative and qualitative approach.A mixed-methods approach was used. – Quantitative study: a cross-sectional voluntary survey was distributed to 68 general practitioners and 18 pharmacists (July–October 2025). – Qualitative study: semi-structured interviews with 8 GPs and 4 pharmacists were analysed using a grounded-theory-inspired method.Participation reached 76%. Accessibility for motor disabilities was generally satisfactory, with over half of GPs offering multiple appointment modes. However, adaptations for cognitive, mental or neurodevelopmental disabilities remained limited. Fewer than one quarter of GPs and one third of pharmacists used more than one communication aid. Interviews highlighted persistent barriers: cost, limited knowledge of regulations, lack of adapted equipment and structural constraints. Despite this, practitioners described concrete solutions across the care pathway: flexible appointment options, extended consultation time, quieter time slots, home visits, pharmacy delivery systems and spatial adaptations. The involvement of staff and caregivers, and a trusting practitioner–patient relationship, were identified as essential facilitators.Combined findings show that professionals actively implement solutions to enhance accessibility, yet significant gaps remain—especially regarding communication and support for cognitive or mental disabilities. Strengthening collaborative practices may help reduce these inequities.Accessibility within the CPTS shows encouraging initiatives but persistent challenges. Targeted improvements, particularly in communication and disability-specific adaptations, are needed to ensure equitable access and support autonomy for all patients.

Patient enrolment in primary care refers to the formal process of registering patients with a specific primary care provider, team, or practice. This approach is often expected to enhance continuity and coordination of care. However, limited information exists on the uptake of patient enrolment and its associated characteristics.This review aimed to estimate the uptake of patient enrolment in primary care and examine factors associated with decisions around enrolment.Eight electronic databases (PubMed, Cochrane Register of Systematic Reviews, Embase, CINAHL, PsycINFO, PAIS, Web of Science, and Scopus) were searched for peer-reviewed articles published from January 2014 to July 2024. Findings from included studies were extracted and synthesised, with uptake estimated through meta-analysis and factors associated with enrolment summarised narratively. Review registration: PROSPERO CRD42024597078.Ten studies across nine publications were included. Of these, eight studies with 27,919,216 participants were included in the meta-analysis. The results showed a pooled patient enrolment uptake rate of 71.4% (95% Confidence Interval [CI]: 13.6-97.5%). There was no significant difference in enrolment rates between population-wide and program-based enrolment (72.4% vs. 73.5%; p=0.980). Several associated factors were identified in three publications. Women showed higher enrolment rates than men (adjusted odds ratio [aOR]=1.07, 95% CI: 1.07-1.08), while recently arrived immigrants in a country had lower enrolment rates than the established population (aOR=0.40, 95% CI: 0.40-0.41). Patients living in small urban/suburban/rural areas had higher enrolment rates than those in large urban/metropolitan regions (aORs: 1.17-2.18). Higher socioeconomic level was associated with increased rates of enrolment. Patients with some specific chronic health conditions, such as those with diagnosed mental illness or substance use disorders, had lower enrolment rates.The findings reveal that more than two-thirds of patients were enrolled with a primary care provider or practice; enrolment was influenced by demographic, geographic, socioeconomic, and clinical factors. Lower enrolment among men, recent immigrants, individuals living in large urban/metropolitan areas, lower socioeconomic groups, and those with certain health conditions may indicate potential barriers to health service access and opportunities for enrolment.Addressing these disparities is essential to promote equitable access and enhance opportunities for continuity and coordination of primary care.

Access to primary care is key to equitable healthcare systems. In France, social inequalities shape healthcare access. While the "ecology of care" model describes contact distribution across care levels, few population-level studies have systematically examined how social deprivation affects primary care utilization. This study aimed to provide a population-based assessment of primary care utilization patterns in France, stratified by social deprivation levels (FDep).- Quantify contacts with medical and paramedical primary health care professionals across deprivation quintiles. - Provide a descriptive analysis of how social deprivation influences access to primary care services.We conducted a nationwide, population-based, cross-sectional study using 2018, 2020 and 2022 data from the French National Health Data System (SNDS), covering 99% of the population. Healthcare utilization was measured as the number of beneficiaries per 1,000 individuals with at least one reimbursement ("contact") in a given month. Social deprivation was assessed using the FDep index, categorizing the population into quintiles. We analyzed contacts with GPs, other medical specialists, nurses, midwives, physiotherapists, and other paramedical professionals. Descriptive statistics were used to compare utilization rates across deprivation levels.While final results are still being processed, preliminary findings suggest significant variations in primary care utilization based on social deprivation. Higher deprivation levels (FDep quintiles 4–5) would be associated with increased contact with GPs and nurses and with descreased contact with other medical specialists and with other paramedical services (e.g., physiotherapists, psychologists).This study will provide a descriptive overview of primary care utilization in France, highlighting potential differences in contact patterns based on social deprivation. Higher deprivation could correlate with more GP/nurse contacts, possibly reflecting greater needs and greater barriers to specialized care and other paramedical use. These findings would align with existing literature on healthcare disparities but extend the analysis to a population-wide scale.Deprivation influences primary care use. This population-based study will offer a detailed snapshot of primary care utilization in France, stratified by social deprivation, and so contribute to a better understanding of healthcare access disparities. Future work will focus on longitudinal analyses to assess trends over time and evaluate policy impacts on reducing inequalities in primary care.

Historically, Persistently or Systematically Marginalized (HPSM) communities are economically and/or socially excluded from the society in which they live by socio-economic status, gender, class, race, ethnicity, age, sexuality or “other” group identity. This study sought to learn from HPSM community members to understand their lived experiences regarding their health, their access to primary care services, and the challenges they face in gaining attachment to PCPs (primary care providers).To understand the experiences of HPSM patients’ regarding their health needs, interactions with PCPs, and access to primary care and related services. Additionally, we interviewed PCPs to understand their experiences serving HPSM patients including the healthcare needs of their patients, barriers and challenges they face when supporting the health needs of patients, their patients’ access to primary care, and supports needed to better serve patients.We conducted a qualitative study in XXX, with patients belonging to HPSM communities and the PCPs serving the communities. A purposive sampling technique was used to recruit participants. Participants were recruited through local community-based organizations (i.e., Homeless shelters, YMCA’s, Libraries, Café’s, Community clinics, Immigration and Educational organizations) and street walks by two research team members.Interviews were conducted between July and December 2025. Data will be analysed using a thematic analysis.Recruitment is ongoing. We have interviewed 20 patients, (13 male), and 6 primary care providers (4 female). Early findings suggest that wait times to receive care, issues with system navigation for patients, primary care provider and allied health staff shortages, a lack of social and living supports, and systemic issues with implicit biases, are challenges to accessing care for patients.This study will help to identify the needs of HPSM patients, who have historically had poorer access to healthcare, and provide new information about the primary care challenges they experience. Furthermore, by considering both patient and provider experiences and perspectives, we can identify gaps and ways to improve care for HPSM patients.The findings from this study will be used to inform policy, practices, planning, and the provision of primary care services in XXX for HPSM patients.

Ensuring equitable access, continuity of care and community-oriented primary care are central to the WONCA Europe framework. In rural settings, barriers such as transport limitations, socioeconomic constraints, digital exclusion and lower health literacy can widen inequalities reducing patient engagement. Inactive or infrequently attending patients are at heightened risk of unmet preventive needs, unmanaged long-term conditions and delayed diagnosis.To develop and evaluate a structured re-engagement programme designed to identify, stratify and reconnect patients who had not contacted the practice for ≥12 months, to determine its impact on access, continuity, equity, and preventive health activity within a rural general-practice population.A mixed-methods retrospective evaluation was undertaken using clinical-system searches to identify 1,049 patients with no recorded engagement in the previous year. Patients were stratified by age, comorbidities and cardiovascular-metabolic risk. A multimodal personalised strategy was deployed, SMS invitations, letters and structured telephone calls supported by care navigation, shared-decision making and flexible appointment options. Quantitative outcomes included re-attendance, uptake of NHS Health Checks, blood pressure reviews, lipid testing and population-screening participation.Inactive patients covered all age groups (0–4 years: 32; 5–11: 145; 12–18: 156; 19–39: 358; 40–74: 349; ≥75: 9). The 40–74-year group showed the greatest unmet clinical need, with many overdue NHS Health Checks and presenting unaddressed hypertension, hypercholesterolaemia or missed screening. Early outcomes indicate that personalised communication and increased appointment flexibility improved re-attendance and enabled more timely cardiovascular-risk identification. Qualitative findings highlighted trust, relational continuity and clear communication as key enablers of re-engagement.As a retrospective service evaluation, findings reflect early outcomes rather than long-term clinical impact, causal inferences cannot be definitively drawn. Digital contact methods, while efficient, may still risk missing the most marginalised groups, and future iterations should consider community-based or partner-organisation outreach to enhance reach. Further evaluation to determine sustainability, cost-effectiveness, and the optimal balance between automated and relational components of the programme.A structured, continuity-focused re-engagement programme can reduce inequities, strengthen community-oriented primary care and support proactive population health management in rural settings. Embedding systematic outreach within routine general-practice processes may provide a scalable model aligned with WONCA principles, improving outcomes for underserved and disengaged populations.

Colorectal cancer (CRC) screening remains suboptimal in Europe, with marked social and territorial disparities. Proactive outreach strategies, particularly in underserved areas, could help reduce these inequalities. The Marsatak project evaluates whether medical students’ phone calls to patients identified as non-up-to-date through health insurance lists can improve CRC screening uptake.To assess whether proactive phone calls made by general practice residents to patients identified as non–up-to-date with colorectal cancer screening can improve screening uptake and help reduce territorial disparities in participation.This prospective interventional study involved 26 general practice residents across multiple primary care centres. Each resident received a list of their supervising physician’s patients who were not up-to-date with CRC screening according to health insurance data. Residents conducted structured phone calls providing information, addressing barriers, and encouraging test completion. All contacts were logged using a standardised data-collection sheet including sociodemographic variables, number of calls required, screening eligibility, patient attitudes, and acceptance or refusal of the FIT testA total of 13,436 patients were contacted. Among them, 7,052 (52.5%) answered the call. Of respondents, 3,543 (50.2%) expressed willingness to complete the FIT after receiving explanations; 1,403 (19.9%) were not eligible (already screened or exempt from screening); 1,545 (21.9%) refused despite discussion; and 798 (11.3%) remained ambivalent. Preliminary analyses show feasibility of the intervention across diverse settings and highlight strong patient receptivity when the call originates from their local care team. Qualitative feedback suggests patients perceived the approach as supportive and valued being personally contacted about prevention.Phone outreach by local healthcare professionals appears to be an effective lever to enhance CRC screening participation, particularly in regions with historically low uptake. Using insurance-generated lists enables targeted action toward populations most at risk of non-participation. Future analyses will determine actual test completion rates at 2 and 6 months and explore factors associated with acceptance, ambivalence, and refusal.The Marsatak intervention demonstrates that personalised phone calls based on up-to-date registries can strengthen CRC screening outreach and may help reduce territorial inequalities in preventive care participation.