Quality of primary care among individuals receiving treatment for opioid use disorder

Canadian family physician: Medecin de famille canadien

Tara Kiran^2¹  Meldon Kahan^4²  Qi Guan^5³  Mina Tadrous^6⁴  Sheryl Spithoff^1⁵  Pamela Leece^7⁶  Wayne Khuu^3⁷  Diana Martins^8⁸  Tara Gomes^9⁹ 

[1]Adjunct Scientist at ICES in Toronto, Associate Scientist in the Li Ka Shing Knowledge Institute at St Michael’s Hospital, Fidani Chair in Improvement and Innovation and Vice-Chair of Quality and Innovation in the Department of Family and Community Medicine at the University of Toronto, and a staff physician and clinician investigator in the Department of Family Medicine at St Michael’s Hospital.^2

[2]Associate Professor in the Department of Family and Community Medicine at the University of Toronto.^4

[3]Doctoral candidate in the Institute of Health Policy, Management and Evaluation at the University of Toronto.^5

[4]Fellow at ICES, a research associate in the Li Ka Shing Knowledge Institute, and Assistant Professor in the Leslie Dan Faculty of Pharmacy at the University of Toronto.^6

[5]Lecturer in the Department of Family and Community Medicine at the University of Toronto in Ontario, a family physician and addiction physician in the Department of Family Medicine at Women’s College Hospital, and a researcher at the Women’s College Research Institute.^1

[6]Public health physician at Public Health Ontario in Toronto, and Assistant Professor in the Department of Family and Community Medicine and in the Dalla Lana School of Public Health at the University of Toronto.^7

[7]Research Analyst at ICES.^3

[8]Research Program Manager at St Michael’s Hospital.^8

[9]Scientist at ICES and in the Li Ka Shing Knowledge Institute, and Assistant Professor in the Institute of Health Policy, Management and Evaluation and in the Leslie Dan Faculty of Pharmacy at the University of Toronto.^9

DOI  :  

学科分类：卫生学

来源: College of Family Physicians of Canada

【 摘 要 】

Objective To determine if people receiving opioid agonist treatment (OAT), a long-term treatment approach, are also receiving high-quality primary care. Design Retrospective cohort study. Setting Ontario. Participants Recipients of public drug benefits who had at least 6 months of continuous use of methadone or buprenorphine between October 1, 2012, and September 30, 2013. Main outcome measures Rates of cancer screening and diabetes monitoring among those who had at least 6 months of continuous OAT were compared with matched controls. Conditional logistic regression models were used to assess differences after adjusting for confounders. In secondary analyses, outcomes by type of OAT and factors related to health care delivery were compared. Results A cohort of 20 406 OAT patients was identified; they had a mean (SD) of 31 (15) physician clinic visits during the 6-month study period. Compared with the control group, OAT patients were less likely to receive screening for cervical cancer (48.7% vs 62.6%; adjusted odds ratio [AOR] of 0.34, 95% CI 0.31 to 0.36), breast cancer (23.3% vs 49.1%; AOR = 0.19, 95% CI 0.16 to 0.24), and colorectal cancer (32.5% vs 49.0%; AOR = 0.34, 95% CI 0.30 to 0.38), and less likely to have monitoring for diabetes (11.7% vs 28.5%; AOR = 0.16, 95% CI 0.13 to 0.21). Patients receiving OAT who were taking buprenorphine, enrolled in a medical home, or seeing a low-volume prescriber were generally more likely to receive cancer screening and diabetes monitoring. Conclusion Patients receiving OAT were less likely to receive chronic disease prevention and management than matched controls were despite frequent health care visits, indicating a gap in equitable access to primary care.

【 授权许可】

CC BY