A cross-sectional study describing factors associated with utilisation of GP services by a cohort of people who inject drugs

BMC Health Services Research

Paul Dietze²  Mark Stoové¹  Dhanya Nambiar² 

[1] Centre for Population Health, Burnet Institute, 85 Commercial Rd, 3004 Melbourne, VIC, Australia;Department of Epidemiology & Preventive Medicine, Monash University, GPO Box 2284, 3001 Melbourne, Victoria, Australia

关键词: Primary care;    Utilisation;    Healthcare;    General practice;    Injecting;   

Others  :  863962
DOI  :  10.1186/1472-6963-14-308

 received in 2013-12-05, accepted in 2014-07-08,  发布年份 2014

【 摘 要 】

Background

People who inject drugs (PWID) use healthcare services, including primary care, at a disproportionately high rate. We investigated key correlates of general practitioner (GP) related service utilisation within a cohort of PWID.

Methods

Using baseline data from a cohort of 645 community-recruited PWID based in Melbourne, Victoria, we conducted a secondary analysis of associations between past month use of GP services unrelated to opioid substitution therapy (OST) and socio-demographic and drug use characteristics and self-reported health using multivariate logistic regression.

Results

Just under one-third (29%) of PWID had accessed GP services in the month prior to being surveyed. Participants who reported living with children (adjusted odds ratio, AOR 1.97, 95% CI 1.04 - 3.73) or having had contact with a social worker in the past month (AOR 1.92, 95% CI 1.24 - 2.98) were more likely to have seen a GP in the past month. Participants who were injecting daily or more frequently (AOR 0.50, 95% CI 0.30 - 0.83) or had a weekly income of less than $400 (AOR 0.59, 95% CI 0.38 - 0.91) were less likely to report having seen a GP in the past month.

Conclusions

Our sample frequently attended GP services for health needs unrelated to OST. Findings highlight both the characteristics of PWID accessing GP services and also those potentially missing out on primary care and preventive services.

【 授权许可】

   
2014 Nambiar et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Arno PS, Budner NS, Selwyn PA, Wasserman WC: Utilization of on-site primary care services by HIV-seropositive and seronegative drug users in a methadone maintenance program. Public Health Rep 1993, 108(4):492+.
• [2]Chitwood DD, Comerford M, McBride DC, McCoy CB, Metsch LR: A comparison of the need for health care and use of health care by injection-drug users, other chronic drug users, and nondrug users. Am Behav Sci 1998, 41(8):1107+.
• [3]Day CA, Islam MM, White A, Reid SE, Hayes S, Haber PS: Development of a nurse-led primary healthcare service for injecting drug users in inner-city Sydney. Aust J Prim Health 2011, 17(1):10-15.
• [4]Kerr T, Wood E, Grafstein E, Ishida T, Shannon K, Lai C, Montaner J, Tyndall MW: High Rates of Primary Care and Emergency Department Use Among Injection Drug Users in Vancouver. J Public Health 2005, 27(1):62-66.
• [5]Palepu A, Strathdee SA, Hogg RS, Anis AH, Rae S, Cornelisse PG, Patrick DM, O’Shaughnessy MV, Schechter MT: The social determinants of emergency department and hospital use by injection drug users in Canada. J Urban Health 1999, 76(4):409-418.
• [6]Cassin S, Geoghegan T, Cox G: Young injectors: a comparative analysis of risk behaviour. Ir J Med Sci 1998, 167(4):234-237.
• [7]Islam MM, Topp L, Iversen J, Day CA, Conigrave KM, Maher L: Healthcare utilisation and disclosure of injecting drug use among clients of Australia’s needle and syringe programs. Aust N Z J Public Health 2013, 37(2):148-154.
• [8]Digiusto E, Treloar C: Equity of access to treatment, and barriers to treatment for illicit drug use in Australia. Addiction 2007, 102(6):958-969.
• [9]Kelly E, McKetine R, McLaren J: Health service utilisation among regular methamphetamine users. In NDARC Technical Report. Sydney: National Drug and Alcohol Research Centre; 2005.
• [10]Andersen R, Newman JF: Societal and individual determinants of medical care utilization in the United States. Milbank Mem Fund Q Health Soc 1973, 51(1):95-124.
• [11]Andersen RM: Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav 1995, 36(1):1-10.
• [12]Neale J, Tompkins C, Sheard L: Barriers to accessing generic health and social care services: a qualitative study of injecting drug users. Health Soc Care Community 2008, 16(2):147-154.
• [13]Ostertag S, Wright BRE, Broadhead RS, Altice FL: Trust and other characteristics associated with health care utilisation by injection drug users. J Drug Issues 2006, 36(4):953-974.
• [14]Holt M, Treloar C, McMillan K, Schultz L, Schultz M, Bath N: Barriers and incentives to treatment for illicit drug users with mental health comorbidities and complex vulnerabilities. In National Drug Strategy, Volume 61. Commonwealth of Australia: Department of Health and Ageing; 2007.
• [15]Aitken C, Kerr T, Hickman M, Stoove M, Higgs P, Dietze P: A cross-sectional study of emergency department visits by people who inject drugs. EMJ Online First 2012, 30(5):421-422.
• [16]DiPietro BY, Kindermann D, Schenkel SM: Ill, Itinerant, and Insured: The Top 20 Users of Emergency Departments in Baltimore City. Scientific World Journal 2012, 2012:726568.
• [17]Islam MM, Topp L, Day C: Opioid substitution therapy clients’ preferences for targeted versus general primary healthcare outlets. Drug Alcohol Rev 2012, 32(2):211-4.
• [18]Hughes C: The Australian (illicit) drug policy timeline: 1985-2012. Drug Policy Modelling Program 2012.
• [19]McDonald P: From Streets to Sidewalks: Developments in Primary Care Services for Injecting Drug Users. Aust J Prim Health 2002, 8(1):65-69.
• [20]Degenhardt L, Knox S, Barker B, Britt H, Shakeshaft A: The management of alcohol, tobacco and illicit drug use problems by general practitioners in Australia. Drug Alcohol Rev 2005, 24(6):499-506.
• [21]Morrison CL, Ruben SM: The development of healthcare services for drug misusers and prostitutes. Postgrad Med J 1995, 71(840):593-597.
• [22]Deehan A, Taylor C, Strang J: The general practitioner, the drug misuser, and the alcohol misuser: major differences in general practitioner activity, therapeutic commitment, and ‘shared care’ proposals. Br J Gen Pract 1997, 47(424):705-709.
• [23]Horyniak D, Higgs P, Jenkinson R, Degenhardt L, Stoove M, Kerr T, Hickman M, Aitken C, Dietze P: Establishing the Melbourne injecting drug user cohort study (MIX): rationale, methods, and baseline and twelve-month follow-up results. Harm Reduction J 2013, 10(1):11. BioMed Central Full Text
• [24]Stafford J, Burns L: AUSTRALIAN DRUG TRENDS 2011: Findings from the Illicit Drug Reporting System (IDRS). In Australian Drug Trends Series. Sydney: National Drug and Alcohol Research Centre, University of New South Wales; 2012.
• [25]Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley K: The AUDIT alcohol consumption questions (AUDITC): an effective brief screening test for problem drinking. Arch Intern Med 1998, 158:1789-1795.
• [26]The International Wellbeing Group: Personal Wellbeing Index (5th Edition). Edited by Group TIW. Melbourne: Australian Centre on Quality of Life, Deakin University; 2013. http://www.deakin.edu.au/research/acqol/instruments/wellbeing-index/pwi-a-english.pdf.
• [27]Dietze P, Stoové M, Miller P, Kinner S, Bruno R, Alati R, Burns L: The self-reported personal wellbeing of a sample of Australian injecting drug users. Addiction 2011, 105(12):2141-8.
• [28]Ware JE: How to score and interpret single-item health status measures: a manual for users of the of the SF-8 health survey: (with a supplement on the SF-6 health survey). Lincoln, RI; Boston, MA: QualityMetric, Inc.; Health Assessment Lab; 2001.
• [29]Aday LA, Andersen RM: A framework for the study of access to medical care. Health Serv Res 1974, 9(3):208-220.
• [30]Ansari Z: A review of literature on access to primary health care. Aust J Prim Health 2007, 13(2):80-95.
• [31]Dietze P, Jenkinson R, Aitken C, Stoové M, Jolley D, Hickman M, Kerr T: The relationship between alcohol use and injecting drug use: impacts on health, crime and wellbeing. Drug Alcohol Depend 2012, 128(1-2):111-5.
• [32]Horyniak D, Dietze P, Degenhardt L, Higgs P, McIlwraith F, Alati R, Bruno R, Lenton S, Burns L: The relationship between age and risky injecting behaviours among a sample of Australian people who inject drugs. Drug Alcohol Depend 2013, 132(3):541-546.
• [33]Gelberg L, Andersen RM, Leake BD: The behavioral model for vulnerable populations: application to medical care use and outcomes for homeless people. Health Services Research. vol. 34 2000, 1273.
• [34]Australian Bureau of Statistics: 6523.0 - Household Income and Income Distribution, Australia, 2007-0. Canberra: Australian Bureau of Statistics; 2007-2008:2007-2008.
• [35]Australian Bureau of Statistics: 6523.0 - Household Income and Income Distribution, Australia, 2009-10. Canberra: Australian Bureau of Statistics; 2009-2010:2009-2010.
• [36]Cummins RA, Woerner J, Weinberg M, Collard J, Hartley-Clark L, Perera C, Horfiniak K: Australian Unity Wellbeing Index Survey 27.0 Part A: The Report "The Wellbeing of Australians – Quantity and Quality of Sleep". Geelong, Victoria: Australian Centre on Quality of Life, Deakin University; 2012.
• [37]Darke S, Ross J, Teesson M, Lynskey M: Health service utilization and benzodiazepine use among heroin users: findings from the Australian Treatment Outcome Study (ATOS). Addiction 2003, 98(8):1129.
• [38]Blackwell D, Martinez ME, Gentleman J, Sanmartin C, Berthelot J-M: Socioeconomic status and utilization of health care services in Canada and the United States: findings from a binational health survey. Med Care 2009, 47(11):1136-1146.
• [39]Schoen C, Doty MM: Inequities in access to medical care in five countries: findings from the 2001 Commonwealth Fund International Health Policy Survey. Health Policy 2004, 67(3):309-322.
• [40]Veugelers PJ, Yip AM: Socioeconomic disparities in health care use: does universal coverage reduce inequalities in health? J Epidemiol Community Health 2003, 57(6):424-428.
• [41]van Doorslaer E, Masseria C, Koolman X: Inequalities in access to medical care by income in developed countries. CMAJ 2006, 174(2):177-183.
• [42]Olsen A, Banwell C, Dance P, Maher L: Positive health beliefs and behaviours in the midst of difficult lives: women who inject drugs. Int J Drug Policy 2012, 23(4):312-318.
• [43]Shah NG, Galai N, Celentano DD, Vlahov D, Strathdee SA: Longitudinal predictors of injection cessation and subsequent relapse among a cohort of injection drug users in Baltimore, MD, 1988–2000. Drug Alcohol Depend 2006, 83(2):147-156.
• [44]Riley ED, Wu AW, Junge B, Marx M, Strathdee SA, Vlahov D: Health services utilization by injection drug users participating in a needle exchange program. Am J Drug Alcohol Abuse 2002, 28(3):497-511.
• [45]Dwyer R, Topp L, Maher L, Power R, Hellard M, Walsh N, Jauncey M, Conroy A, Lewis J, Aitken C: Prevalences and correlates of non-viral injecting-related injuries and diseases in a convenience sample of Australian injecting drug users. Drug Alcohol Depend 2009, 100(1–2):9-16.
• [46]Lloyd-Smith E, Wood E, Zhang R, Tyndall M, Sheps S, Montaner J, Kerr T: Determinants of hospitalization for a cutaneous injection-related infection among injection drug users: a cohort study. BMC Public Health 2010, 10(1):327. BioMed Central Full Text
• [47]Fraser S, Moore D: Dazzled by unity? Order and chaos in public discourse on illicit drug use. Soc Sci Med 2008, 66(3):740-752.
• [48]Cameron J, Davies R: Self-identified occupational competencies, limitations and priorities for change in the occupational lives of people with drug misuse problems. Br J Occup Ther 2010, 73:251+.
• [49]Cleaver H, Unell I, Aldgate J: Children’s Needs-Parenting Capacity, vol. 2. 2nd edition. London: TSO; 2011.
• [50]Callaghan T, Crimmins J, Schweitzer RD: Children of substance-using mothers: child health engagement and child protection outcomes. J Paediatr Child Health 2011, 47(4):223-227.
• [51]Priebe S, Matanov A, Schor R, Straßmayr C, Barros H, Barry MM, Díaz-Olalla JM, Gabor E, Greacen T, Holcnerová P, Kluge U, Lorant V, Moskalewicz J, Schene AH, Macassa G, Gaddinin A: Good practice in mental health care for socially marginalised groups in Europe: a qualitative study of expert views in 14 countries. BMC Public Health 2012, 12:248. BioMed Central Full Text
• [52]Neale J, Sheard L, Tompkins CN: Factors that help injecting drug users to access and benefit from services: a qualitative study. Subst Abuse Treat Prev Policy 2007., 2(31)
• [53]Freedman RI, Nichols AD, Ward RL: Uncovering health care inequalities among adults with intellectual and developmental disabilities. Health Social Work 2010, 35(4):280.
• [54]Islam MM, Topp L, Conigrave KM, van Beek I, Maher L, White A, Rodgers C, Day CA: The reliability of sensitive information provided by injecting drug users in a clinical setting: clinician-administered versus audio computer-assisted self-interviewing (ACASI). AIDS Care 2012, 24(12):1496-1503.
• [55]Cronquista A, Edwardsb V, Galeab S, Latkab M, Vlahov D: Health care utilization among young adult injection drug users in Harlem, New York. J Subst Abuse 2001, 13:17-27.
• [56]Roe B, Beynon C, Pickering L, Duffy P: Experiences of drug use and ageing: health, quality of life, relationship and service implications. J Adv Nurs 2010, 66(9):1968-1979.
• [57]French MT, McGearyb KA, Chitwoodc DD, McCoya CB: Chronic illicit drug use, health services utilization and the cost of medical care. Soc Sci Med 2000, 50:1703-1713.