Representations and experiences of primary care among migrants receiving state medical assistance

Context. Illegal migrants suffer from lower health condition compared to the general population. Despite social insurance has been developed in France to give them a theoretical access to health care ("aide medicale de l'Etat", AME), they still face barriers for accessing health care. Aim. To explore the representations and experiences of primary care of migrants receiving AME. Method. A qualitative study was carried out among migrants benefiting from the AME, recruited by reasoned sampling through their general practitioners and during maternal and child protection consultations, between December 2016 and April 2017. Semi-structured interviews explored the representations of care and expectations of AME beneficiaries towards their general practitioner (GP). An inductive content analysis of these interviews was performed. Results. A total of 14 patients were interviewed. The irregularity of residence, combined with their social and health vulnerability, shaped their representations of health care. Recourse to primary care was determined by the quality of the specific social network (associations, community links, social workers) supporting these patients. Patients expected the GP to have skills mostly in relational aspects and to provide care adapted to their social context. Although theoretically not concerned by the personal physician path, they often identified or wished to be able to identify their GP as "personal physician". Conclusion. The specific social network of migrants benefiting from the AME is decisive in their recourse to primary care. The patient-centred approach, integrating consideration of their social condition, and promoting a high-quality physician-patient relationship, is a particularly necessary positioning to improve the care experience for these patients.