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المؤلفون: Nicola Diliso, Pam Oickle, Claire Kendall, Mark W. Tyndall, Jessy Donelle, Sean LeBlanc, Zack Marshall, Alana Martin, Robert W. Boyd, Brad Renaud, Dave Pineau, Ahmed M. Bayoumi, Lisa M. Boucher
المصدر: BMC Health Services Research, Vol 20, Iss 1, Pp 1-12 (2020)
BMC Health Services Researchمصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Substance-Related Disorders, Population, 030508 substance abuse, Health administration, Cohort Studies, Drug Users, 03 medical and health sciences, 0302 clinical medicine, Acute care, medicine, Humans, 030212 general & internal medicine, education, Ontario, education.field_of_study, Primary Health Care, business.industry, lcsh:Public aspects of medicine, Health Policy, Nursing research, Public health, lcsh:RA1-1270, Emergency department, Middle Aged, Patient Acceptance of Health Care, Primary care, medicine.disease, Health administrative data, Comorbidity, 3. Good health, Family medicine, Female, 0305 other medical science, business, People who use drugs, Research Article, Cohort study
الوصف: Background There may be less primary health care engagement among people who use drugs (PWUD) than among the general population, even though the former have greater comorbidity and more frequent use of emergency department care. We investigated factors associated with primary care engagement among PWUD. Methods The Participatory Research in Ottawa: Understanding Drugs (PROUD) cohort study meaningfully engaged and trained people with lived experience to recruit and survey marginalized PWUD between March–December 2013. We linked this survey data to provincial-level administrative databases held at ICES. We categorized engagement in primary care over the 2 years prior to survey completion as: not engaged ( Results Characteristics of 663 participants included a median age of 43 years, 76% men, and 67% living in the two lowest income quintile neighborhoods. Despite high comorbidity and a median of 4 (interquartile range 0–10) primary care visits in the year prior to survey completion, only 372 (56.1%) were engaged in primary care. Engagement was most strongly associated with the following factors: receiving provincial benefits, including disability payments (adjusted odds ratio [AOR] 4.14 (95% confidence interval [CI] 2.30 to 7.43)) or income assistance (AOR 3.69 (95% CI 2.00 to 6.81)), having ever taken methadone (AOR 3.82 (95% CI 2.28 to 6.41)), mental health comorbidity (AOR 3.43 (95% CI 2.19 to 5.38)), and having stable housing (AOR 2.09 (95% CI 1.29 to 3.38)). Conclusions Despite high comorbidity, engagement in primary care among PWUD was low. Our findings suggest that social care (housing, disability, and income support) and mental health care are associated with improved primary care continuity; integration of these care systems with primary care and opioid substitution therapy may lessen the significant morbidity and acute care use among PWUD.
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المؤلفون: Claire Kendall, Rob Boyd, Sean LeBlanc, Tiffany Rose, Pam Oickle, Nicola Diliso, Amy E. Mark, Ahmed M. Bayoumi, Dave Pineau, Olivia M. Lee, Brad Renaud, Lisa M. Boucher, Zack Marshall, Alana Martin, Mark W. Tyndall
المصدر: Harm Reduction Journal
Harm Reduction Journal, Vol 14, Iss 1, Pp 1-10 (2017)مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Emergency department visits, Canada, Substance-Related Disorders, Population, 030508 substance abuse, Medicine (miscellaneous), Poison control, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Acute care, medicine, Humans, 030212 general & internal medicine, education, Hospital admissions, Retrospective Studies, education.field_of_study, business.industry, lcsh:Public aspects of medicine, 1. No poverty, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, Emergency department, Odds ratio, Patient Acceptance of Health Care, medicine.disease, Comorbidity, Health administrative data, 3. Good health, Hospitalization, Psychiatry and Mental health, Cohort, Emergency medicine, Female, Matched control group, Erratum, 0305 other medical science, business, Emergency Service, Hospital, People who use drugs, Self-reported data, Cohort study
الوصف: Background The health of people who use drugs (PWUD) is characterized by multimorbidity and chronicity of health conditions, necessitating an understanding of their health care utilization. The objective of this study was to evaluate emergency department (ED) visits and hospital admissions among a cohort of PWUD. Methods We used a retrospective observational design between 2012 and 2013. The population was a marginalized cohort of PWUD (the PROUD study) for whom survey data was linked (n = 663) to provincial health administrative data housed at the Institute for Clinical Evaluative Sciences. We constructed a 5:1 comparison group matched by age, sex, income quintile, and region. The main outcomes were defined as having two or more ED visits, or one or more hospital admissions, in the year prior to survey completion. We used multivariable logistic regression analyses to identify factors associated with these outcomes. Results Compared to the matched cohort, PWUD had higher rates of ED visits (rate ratio [RR] 7.0; 95% confidence interval [95% CI] 6.5–7.6) and hospitalization (RR 7.7; 95% CI 5.9–10.0). After adjustment, factors predicting more ED visits were receiving disability (adjusted odds ratio [AOR] 3.0; 95% CI 1.7–5.5) or income assistance (AOR 2.7; 95% CI 1.5–5.0), injection drug use (AOR 2.1; 95% CI 1.3–3.4), incarceration within 12 months (AOR 1.6; 95% CI 1.1–2.4), mental health comorbidity (AOR 2.1; 95% CI 1.4–3.1), and a suicide attempt within 12 months (AOR 2.1; 95% CI 1.1–3.4). Receiving methadone (AOR 0.5; 95% CI 0.3–0.9) and having a regular family physician (AOR 0.5; 95% CI 0.2–0.9) were associated with lower odds of having more ED visits. Factors associated with more hospital admissions included Aboriginal identity (AOR 2.4; 95% CI 1.4–4.1), receiving disability (AOR 2.4; 95% CI 1.1–5.4), non-injection drug use (opioids and non-opioids) (AOR 2.2; 95% CI 1.1–4.4), comorbid HIV (AOR 2.4; 95% CI 1.2–5.6), mental health comorbidity (AOR 2.4; 95% CI 1.3–4.2), and unstable housing (AOR 1.9; 95% CI 1.0–3.4); there were no protective factors for hospitalization. Conclusions Improved post-incarceration support, housing services, and access to integrated primary care services including opioid replacement therapy may be effective interventions to decrease acute care use among PWUD, including targeted approaches for people receiving social assistance or with mental health concerns.
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