TY - JOUR
KW - Adult
KW - Cohort Studies
KW - Drug Users/statistics & numerical data
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Ontario/epidemiology
KW - Patient Acceptance of Health Care/statistics & numerical data
KW - Primary Health Care/statistics & numerical data
KW - Substance-Related Disorders/epidemiology
KW - Health administrative data
KW - people who use drugs
KW - primary care
AU - C. E. Kendall
AU - L. M. Boucher
AU - J. Donelle
AU - A. Martin
AU - Z. Marshall
AU - R. Boyd
AU - P. Oickle
AU - N. Diliso
AU - D. Pineau
AU - B. Renaud
AU - S. LeBlanc
AU - M. Tyndall
AU - A. M. Bayoumi
A1 - 
AB - 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 (< 3 outpatient visits to the same family physician) versus engaged in care (3+ visits to the same family physician). We used multivariable logistic regression to determine factors associated with engagement in primary care. 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.
AD - Bruyère Research Institute, 43 Bruyère Street, Annex E, Ottawa, Ontario, K1N 5C8, Canada. ckendall@uottawa.ca.; Bruyère Research Institute, 43 Bruyère Street, Annex E, Ottawa, Ontario, K1N 5C8, Canada.; ICES, Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Box 684, Administrative Services Building, 1st Floor, Ottawa, Ontario, K1Y 4E9, Canada.; Somerset West Community Health Centre, 55 Eccles Street, Ottawa, Ontario, K1R 6S3, Canada.; PROUD Community Advisory Committee, Ottawa, Ontario, Canada.; School of Social Work, McGill University, 3506 University Street, Room 421, Montreal, Quebec, H3A 2A7, Canada.; Sandy Hill Community Health Centre, 221 Nelson Street, Ottawa, Ontario, K1N 1C7, Canada.; Ottawa Public Health, 179 Clarence Street, Ottawa, Ontario, K1N 1B3, Canada.; PROUD Community Advisory Committee, Ottawa, Ontario, Canada.; PROUD Community Advisory Committee, Ottawa, Ontario, Canada.; PROUD Community Advisory Committee, Ottawa, Ontario, Canada.; PROUD Community Advisory Committee, Ottawa, Ontario, Canada.; Drug Users Advocacy League, Ottawa, Ontario, Canada.; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada.; MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.
BT - BMC health services research
C5 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
CP - 1
DO - 10.1186/s12913-020-05670-z
IS - 1
JF - BMC health services research
LA - eng
M1 - Journal Article
N2 - 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 (< 3 outpatient visits to the same family physician) versus engaged in care (3+ visits to the same family physician). We used multivariable logistic regression to determine factors associated with engagement in primary care. 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.
PY - 2020
SN - 1472-6963; 1472-6963
SP - 020
EP - z
EP - 837+
T1 - Engagement in primary health care among marginalized people who use drugs in Ottawa, Canada
T2 - BMC health services research
TI - Engagement in primary health care among marginalized people who use drugs in Ottawa, Canada
U1 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
U2 - 32894114
U3 - 10.1186/s12913-020-05670-z
VL - 20
VO - 1472-6963; 1472-6963
Y1 - 2020
Y2 - Sep 7
ER -