Engagement in primary health care among marginalized people who use drugs in Ottawa, Canada

Abstract

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.

Self-reported impacts of the COVID-19 pandemic among people who use drugs: a rapid assessment study in Montreal, Canada

“…The Big Events conceptual model developed for COVID-19 did not outline possible impacts on non-addiction health care services (e.g. emergency departments), which are nevertheless frequently utilized by PWUD [ 27 ], and were perceived as having become harder to access by our participants. The model did not propose impacts on housing, which is both a crucial health determinant among PWUD [ 28 ], and a central issue for pandemic control [ 29 ].…”

HIV related stigma associated with social support, alcohol use disorders, depression, anxiety, and suicidal ideation among people living with HIV: a systematic review and meta-analysis

“…Berger Stigma Scale [54], HIV Stigma Measure [55], Internalized AIDS-Related Stigma Scale [56], and Demi-HIV Stigma Scale were the most frequently applied tools for measuring HIV-related stigma. The scales, including the Center for Epidemiologic Studies Depression Scale and the Brief Symptom Inventory (BSI) depression subscale [57], the BSI anxiety subscale [57], state anxiety [58], and the Symptom Check List-90-R [59], were employed to measure depression and anxiety. The Social Support Questionnaire [60] and the Medical Outcomes Study-Social Support Subscale [61] were employed to measure social support.…”

Perceived availability and carriage of take-home naloxone and factors associated with carriage among people who inject drugs in England, Wales and Northern Ireland

“…In our study, 77.2% participants reported being currently prescribed drug treatment, whereas the coverage of opioid agonist treatment among PWID in the UK is estimated at 55%-65%(European Monitoring Center for Drugs and Drug Addiction, 2017; Larney et al, 2017). Since PWID who are not engaged in treatment or with other health and social services are oftentimes younger, have recently started injecting drugs, and experience more disadvantage and harm (Artenie et al, 2015;Kendall et al, 2020;Riley et al, 2002) their levels of perceived availability and carriage of naloxone may be lower relative to those who are in contact with services. Future research is needed to characterise how these groups engage with THN programmes.…”