Increasing inequalities in accessibility to primary care has generated medical deserts. Identifying them is key to target the geographic areas where action is needed. An extensive definition of primary care has been promoted by the World Health Organization: a first level of contact with the health system, which involves the co-presence of different categories of health professionals alongside the general practitioner for the diagnosis and treatment of patients. Previous analyses have focused mainly on a single type of provider while this study proposes an integrated approach including various ones to define medical deserts in primary care. Our empirical approach focuses on the first point of contact with the health system: general practitioners, proximity primary care providers (nurses, physiotherapists, pharmacies, laboratories, and radiologists), and emergency services. A multiple analysis approach was performed, to classify French municipalities using the information on the evolution and needs of health care accessibility, combining a principal component analysis and a hierarchical ascending classification. Two clusters of medical deserts were identified with low accessibility to all healthcare professionals, socio-economic disadvantages, and a decrease in care supply. In other clusters, accessibility difficulties only concern a part of the health supply considered, which raises concern for the efficiency of primary care for optimal healthcare pathways. Even for clusters with better accessibility, issues were identified, such as a decrease and high needs of health care supply, revealing potential future difficulties. This work proposes a multi-professional and multi-dimensional approach to medical deserts based mainly on an extensive definition of primary care that shows the relevance of the co-presence of various healthcare professionals. The classification also makes it possible to identify areas with future problems of accessibility and its potential consequences. This framework could be easily applied to other countries according to their available data and their health systems’ specificities.

中文翻译：

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描述医疗荒漠的法国分类：基于与医疗保健系统的首次接触的多专业方法

获得初级保健的不平等日益加剧，造成了医疗荒漠。识别它们是针对需要采取行动的地理区域的关键。世界卫生组织对初级保健提出了广泛的定义：与卫生系统的第一级接触，包括不同类别的卫生专业人员与全科医生共同在场，对患者进行诊断和治疗。先前的分析主要集中于单一类型的提供者，而本研究提出了一种包括各种方法的综合方法来定义初级保健中的医疗荒漠。我们的实证方法侧重于与卫生系统的第一个接触点：全科医生、邻近初级保健提供者（护士、物理治疗师、药房、实验室和放射科医生）和紧急服务。采用多重分析方法，利用医疗保健可及性的演变和需求信息，结合主成分分析和层次升序分类，对法国城市进行分类。确定了两类医疗荒漠，即所有医疗保健专业人员的可及性较低、社会经济不利以及护理供应减少。在其他集群中，可及性困难仅涉及所考虑的医疗供应的一部分，这引起了人们对初级保健最佳医疗保健途径效率的担忧。即使对于交通便利的集群，也发现了一些问题，例如医疗保健供应的减少和高需求，揭示了未来潜在的困难。这项工作主要基于初级保健的广泛定义，提出了一种解决医疗沙漠的多专业和多维度的方法，该定义显示了各种医疗保健专业人员共同存在的相关性。该分类还可以识别未来存在无障碍问题的区域及其潜在后果。根据其他国家的现有数据和卫生系统的特殊性，该框架可以很容易地应用于其他国家。