Rupinder Brar1, M-J Milloy2, Kora DeBeck3, Ekaterina Nosova4, Seonaid Nolan5, Rolando Barrios6, Evan Wood7, Kanna Hayashi8. 1. Family physician, Clinical Assistant Professor in the Department of Family Practice at the University of British Columbia, and a researcher at the British Columbia Centre on Substance Use (BCCSU) in Vancouver. 2. Assistant Professor in the Department of Medicine at the University of British Columbia and a research scientist at the BCCSU. 3. Assistant Professor in the School of Public Policy at Simon Fraser University in Burnaby, BC, and a research scientist at the BCCSU. 4. Statistician at the BCCSU. 5. Assistant Professor in the Department of Medicine at the University of British Columbia and a clinician scientist at the BCCSU. 6. Senior Medical Director of the British Columbia Centre for Excellence in HIV/AIDS in Vancouver. 7. Professor of Medicine at the University of British Columbia and is an addiction medicine physician and clinician scientist at the BCCSU. 8. Assistant Professor in the Faculty of Health Sciences at Simon Fraser University and a research scientist at the BCCSU. bccsu-kh@bccsu.ubc.ca.
Abstract
OBJECTIVE: To examine the prevalence and correlation of self-reported inability to access community primary care clinics among people who inject drugs (PWID). DESIGN: Self-report questionnaire data. SETTING: Vancouver, BC. PARTICIPANTS: Data were derived from 3 prospective cohort studies of PWID between 2013 and 2016. MAIN OUTCOME MEASURES: Multivariable generalized estimating equations were used to determine prevalence of and reasons for self-reported inability to access primary care, as well as factors associated with inability to access care. RESULTS: Of 1396 eligible participants, including 525 (37.6%) women, 209 (15.0%) persons were unable to access a primary care clinic at some point during the study period. In the multivariable analysis, factors independently associated with inability to access clinics included ever being diagnosed with a mental health disorder (adjusted odds ratio [AOR] = 1.63, 95% CI 1.14 to 2.35), dealing drugs (AOR = 1.60, 95% CI 1.15 to 2.22), using emergency services (AOR = 1.51, 95% CI 1.13 to 2.02), being female (AOR = 1.49, 95% CI 1.08 to 2.08), and testing positive for HIV (AOR = 0.47, 95% CI 0.30 to 0.72) (for all factors, P < .05). CONCLUSION: Specific exposures were linked to challenges in accessing primary care among the sample of PWID, even in a publicly funded health care setting. Notably, models designed for care of people with HIV appear to increase access to primary care among PWID. Further research is needed to determine how to effectively treat accompanying mental illness, how to provide women-centred services, and how to connect people with primary care who would likely otherwise go to the emergency department.
OBJECTIVE: To examine the prevalence and correlation of self-reported inability to access community primary care clinics among people who inject drugs (PWID). DESIGN: Self-report questionnaire data. SETTING: Vancouver, BC. PARTICIPANTS: Data were derived from 3 prospective cohort studies of PWID between 2013 and 2016. MAIN OUTCOME MEASURES: Multivariable generalized estimating equations were used to determine prevalence of and reasons for self-reported inability to access primary care, as well as factors associated with inability to access care. RESULTS: Of 1396 eligible participants, including 525 (37.6%) women, 209 (15.0%) persons were unable to access a primary care clinic at some point during the study period. In the multivariable analysis, factors independently associated with inability to access clinics included ever being diagnosed with a mental health disorder (adjusted odds ratio [AOR] = 1.63, 95% CI 1.14 to 2.35), dealing drugs (AOR = 1.60, 95% CI 1.15 to 2.22), using emergency services (AOR = 1.51, 95% CI 1.13 to 2.02), being female (AOR = 1.49, 95% CI 1.08 to 2.08), and testing positive for HIV (AOR = 0.47, 95% CI 0.30 to 0.72) (for all factors, P < .05). CONCLUSION: Specific exposures were linked to challenges in accessing primary care among the sample of PWID, even in a publicly funded health care setting. Notably, models designed for care of people with HIV appear to increase access to primary care among PWID. Further research is needed to determine how to effectively treat accompanying mental illness, how to provide women-centred services, and how to connect people with primary care who would likely otherwise go to the emergency department.
Authors: Bradley M Mathers; Louisa Degenhardt; Benjamin Phillips; Lucas Wiessing; Matthew Hickman; Steffanie A Strathdee; Alex Wodak; Samiran Panda; Mark Tyndall; Abdalla Toufik; Richard P Mattick Journal: Lancet Date: 2008-09-23 Impact factor: 79.321
Authors: A Palepu; S A Strathdee; R S Hogg; A H Anis; S Rae; P G Cornelisse; D M Patrick; M V O'Shaughnessy; M T Schechter Journal: J Urban Health Date: 1999-12 Impact factor: 3.671
Authors: Allison Carter; Jeong Eun Min; William Chau; Viviane D Lima; Mary Kestler; Neora Pick; Deborah Money; Julio S G Montaner; Robert S Hogg; Angela Kaida Journal: PLoS One Date: 2014-03-18 Impact factor: 3.240