. 2020 Sep 7;20(1):837.

doi: 10.1186/s12913-020-05670-z.

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

Claire E Kendall¹, Lisa M Boucher², Jessy Donelle³, Alana Martin^{4

5}, Zack Marshall⁶, Rob Boyd⁷, Pam Oickle⁸, Nicola Diliso⁵, Dave Pineau⁵, Brad Renaud⁵, Sean LeBlanc^{5

9}, Mark Tyndall¹⁰, Ahmed M Bayoumi¹¹

Affiliations

¹ Bruyère Research Institute, 43 Bruyère Street, Annex E, Ottawa, Ontario, K1N 5C8, Canada. ckendall@uottawa.ca.
² Bruyère Research Institute, 43 Bruyère Street, Annex E, Ottawa, Ontario, K1N 5C8, Canada.
³ ICES, Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Box 684, Administrative Services Building, 1st Floor, Ottawa, Ontario, K1Y 4E9, Canada.
⁴ Somerset West Community Health Centre, 55 Eccles Street, Ottawa, Ontario, K1R 6S3, Canada.
⁵ PROUD Community Advisory Committee, Ottawa, Ontario, Canada.
⁶ School of Social Work, McGill University, 3506 University Street, Room 421, Montreal, Quebec, H3A 2A7, Canada.
⁷ Sandy Hill Community Health Centre, 221 Nelson Street, Ottawa, Ontario, K1N 1C7, Canada.
⁸ Ottawa Public Health, 179 Clarence Street, Ottawa, Ontario, K1N 1B3, Canada.
⁹ Drug Users Advocacy League, Ottawa, Ontario, Canada.
¹⁰ School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada.
¹¹ 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.

PMID: 32894114
PMCID: PMC7487534
DOI: 10.1186/s12913-020-05670-z

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

Claire E Kendall et al. BMC Health Serv Res. 2020.

. 2020 Sep 7;20(1):837.

doi: 10.1186/s12913-020-05670-z.

Authors

Affiliations

¹ Bruyère Research Institute, 43 Bruyère Street, Annex E, Ottawa, Ontario, K1N 5C8, Canada. ckendall@uottawa.ca.
² Bruyère Research Institute, 43 Bruyère Street, Annex E, Ottawa, Ontario, K1N 5C8, Canada.
³ ICES, Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Box 684, Administrative Services Building, 1st Floor, Ottawa, Ontario, K1Y 4E9, Canada.
⁴ Somerset West Community Health Centre, 55 Eccles Street, Ottawa, Ontario, K1R 6S3, Canada.
⁵ PROUD Community Advisory Committee, Ottawa, Ontario, Canada.
⁶ School of Social Work, McGill University, 3506 University Street, Room 421, Montreal, Quebec, H3A 2A7, Canada.
⁷ Sandy Hill Community Health Centre, 221 Nelson Street, Ottawa, Ontario, K1N 1C7, Canada.
⁸ Ottawa Public Health, 179 Clarence Street, Ottawa, Ontario, K1N 1B3, Canada.
⁹ Drug Users Advocacy League, Ottawa, Ontario, Canada.
¹⁰ School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada.
¹¹ 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.

PMID: 32894114
PMCID: PMC7487534
DOI: 10.1186/s12913-020-05670-z

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.

Keywords: Health administrative data; People who use drugs; Primary care.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Distribution of primary care visits in year prior to survey completion

See this image and copyright information in PMC

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

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

Authors

Affiliations

Abstract

Conflict of interest statement

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