Suboptimal nonmedical qualities of primary care linked with care avoidance among people who use drugs in a Canadian setting amid an integrated health care reform.
Suboptimal nonmedical qualities of primary care linked with care avoidance among people who use drugs in a Canadian setting amid an integrated health care reform.
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DOI：
10.1016/j.jsat.2022.108784
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发表时间：
2022-08
影响因子：
3.9
通讯作者：
Hayashi, Kanna
中科院分区：
文献类型：
--
作者：
Moallef, Soroush;Dale, Laura;Homayra, Fahmida;Zonneveld, Cristy;Milloy, M-J;Nosyk, Bohdan;Hayashi, Kanna
使用无管制药物（PWUD）的人往往面临重大障碍，从而避免寻求医疗保健。在加拿大温哥华，2016年开始了一项社区医疗体系改革，以改善医疗服务的提供和质量。在这项改革之后，我们试图确定在这种情况下，PWUD患者逃避医疗服务的普遍程度及其与急诊科使用的关系，并检查患者报告的医疗服务的非医疗质量（“反应性”）。该研究的数据来自2017-18年温哥华社区招募的PWUD的两项前瞻性队列研究。响应性通过世界卫生组织的标准化测量确定，我们评估了响应性的七个领域（尊严、自主、沟通、保密、及时关注、提供者选择和基本设施质量）。该研究使用皮尔逊卡方检验来检验那些避免护理和没有避免护理的人在反应性方面的差异。研究小组使用多变量逻辑回归来确定由于过去的虐待而避免护理与急诊科使用之间的关系，并对潜在的混杂因素进行了调整。在889名参与者中，520名（58.5%）是男性，204名（22.9%）报告逃避医疗保健，最常见的是慢性疼痛（47.4%）。总的来说，6.6%到36.2%的人报告说，在所有七个测量的响应性领域中，他们的水平不是最优的（即，并不总是达到预期的质量）。在所有领域中，逃避治疗的患者报告次优质量的比例显著高于未接受治疗的患者，包括尽快治疗（51.0%对31.8%）、认真倾听（44.1%对20.4%）和参与医疗保健决策（27.9%对12.7%）（均p < 0.05）。在多变量分析中，逃避医疗保健与自我报告的急诊科使用独立相关（调整优势比= 1.49；95%可信区间：1.01-2.19）。我们发现，近四分之一的PWUD样本由于过去的虐待而避免寻求医疗保健，所有七个测量的反应性领域都是次优的，并且与逃避有关。报告逃避医疗保健的个人更有可能报告急诊使用。需要采取多层次的干预措施来补救卫生保健的次优质量，从而减少逃避保健的现象。
People who use unregulated drugs (PWUD) often face significant barriers to—and thereby avoid seeking—health care. In Vancouver, Canada, a neighborhood-wide health care system reform began in 2016 to improve health care delivery and quality. In the wake of this reform, we sought to determine the prevalence of health care avoidance and its association with emergency department use among PWUD in this setting and examine patient-reported nonmedical qualities of health care (“responsiveness”). The study derived data from two prospective cohort studies of community-recruited PWUD in Vancouver in 2017–18. Responsiveness was ascertained by the World Health Organizations’ standardized measurements and we evaluated seven domains of responsiveness (dignity, autonomy, communication, confidentiality, prompt attention, choice of provider, and quality of basic amenities). The study used Pearson chi-squared test to examine differences in responsiveness between those who did and did not avoid care. The study team used multivariable logistic regression to determine the relationship between care avoidance due to past mistreatment and emergency department use, adjusting for potential confounders. Among 889 participants, 520 (58.5%) were male, 204 (22.9%) reported avoiding health care, most commonly for chronic pain (47.4%). Overall, 6.6% to 36.2% reported suboptimal levels (i.e., not always meeting the expected quality) across all seven measured domain of responsiveness. Proportions reporting suboptimal qualities were significantly higher among those who avoided care than those who did not across all domains, including care as soon as wanted (51.0% vs. 31.8%), listened to carefully (44.1% vs. 20.4%), and involved in health care decision-making (27.9% vs. 12.7%) (all p < 0.05). In multivariable analyses, avoidance of health care was independently associated with self-reported emergency department use (adjusted odds ratio = 1.49; 95% confidence interval:1.01–2.19). We found that almost a quarter of our sample of PWUD avoided seeking health care due to past mistreatment, and all seven measured domains of responsiveness were suboptimal and linked with avoidance. Individuals who reported avoidance of health care were significantly more likely to report emergency department use. Multi-level interventions are needed to remedy the suboptimal qualities of health care and thereby reduce care avoidance.
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影响因子：
1.3
作者：
Habib, S. E.;Adorjany, L. V.
通讯作者：
Adorjany, L. V.
影响因子：
5.4
作者：
McNeil, Ryan;Kerr, Thomas;Small, Will
通讯作者：
Small, Will
影响因子：
2
作者：
McCoy, CB;Metsch, LR;Miles, C
通讯作者：
Miles, C
DOI：
10.1007/s11524-012-9771-x
发表时间：
2013-06-01
影响因子：
6.6
作者：
Linden, Isabelle Aube;Mar, issa Y.;Krausz, Michael
通讯作者：
Krausz, Michael
影响因子：
3.4
作者：
Friedmann, PD;Lemon, SC;D'Aunno, TA
通讯作者：
D'Aunno, TA