Cohort study of team-based care among marginalized people who use drugs in Ottawa.

Autor:	Kendall CE; Associate Professor in the Department of Family Medicine and is cross-appointed to the School of Epidemiology and Public Health at the University of Ottawa in Ontario; Senior Investigator at the Bruyère Research Institute in Ottawa; a practising family physician with the Bruyère Family Health Team; Adjunct Scientist at ICES in Toronto, Ont; Affiliate Investigator in the Clinical Epidemiology Program at the Ottawa Hospital Research Institute; Affiliate Scientist in the Li Ka Shing Knowledge Institute at St Michael's Hospital in Toronto; and Associate Dean of Social Accountability in the Faculty of Medicine at the University of Ottawa. ckendall@uottawa.ca., Boucher LM; PhD candidate at the University of Ottawa and the Bruyère Research Institute., Donelle J; Analyst at ICES., Martin A; Member of the Participatory Research in Ottawa: Understanding Drugs (PROUD) Community Advisory Committee., Marshall Z; Assistant Professor in the School of Social Work at McGill University in Montreal, Que., Boyd R; Oasis Program Director at Sandy Hill Community Centre in Ottawa., Oickle P; Program Manager in Infectious Disease and Sexual Health Services at Ottawa Public Health., Diliso N; Member of the PROUD Community Advisory Committee., Pineau D; Member of the PROUD Community Advisory Committee., Renaud B; Former member of the PROUD Community Advisory Committee., LeBlanc S; Community Principal Investigator and a member of the PROUD Community Advisory Committee., Tyndall M; Professor in the School of Population and Public Health at the University of British Columbia in Vancouver., Bayoumi AM; Senior Adjunct Scientist at ICES, Associate Professor in the Department of Medicine and Institute of Health Policy at the University of Toronto, and Scientist in the Li Ka Shing Knowledge Institute at St Michael's Hospital.
Jazyk:	angličtina
Zdroj:	Canadian family physician Medecin de famille canadien [Can Fam Physician] 2022 Feb; Vol. 68 (2), pp. 117-127.
DOI:	10.46747/cfp.6802117
Abstrakt:	Objective: To describe team-based care use among a cohort of people who use drugs (PWUD) and to determine factors associated with receipt of team-based care. Design: A cohort study using survey data collected between March and December 2013. These data were then linked to provincial-level health administrative databases to assess patterns of primary care among PWUD in the 2 years before survey completion. Setting: Ottawa, Ont. Participants: Marginalized PWUD 16 years of age or older. Main Outcome Measures: Patients were assigned to primary care models based on survey responses and then were categorized as attached to team-based medical homes, attached to non-team-based medical homes, not attached to a medical home, and no primary care. Descriptive statistics and multinomial logistic regression were used to determine associations between PWUD and medical home models. Results: Of 663 total participants, only 162 (24.4%) received team-based care, which was associated with high school level of education (adjusted odds ratio [AOR] = 2.18; 95% CI 1.13 to 4.20), receipt of disability benefits (AOR = 2.47; 95% CI 1.22 to 5.02), and HIV infection (AOR = 2.88; 95% CI 1.28 to 6.52), and was inversely associated with recent overdose (AOR = 0.49; 95% CI 0.25 to 0.94). In comparison, 125 (18.8%) received non-team-based medical care, which was associated with university or college education (AOR = 2.31; 95% CI 1.04 to 5.15) and mental health comorbidity (AOR = 4.18; 95% CI 2.33 to 7.50), and was inversely associated with being detained in jail in the previous 12 months (AOR = 0.51; 95% CI 0.28 to 0.90). Conclusion: Although team-based, integrated models of care will benefit disadvantaged groups the most, few PWUD receive such care. Policy makers should mitigate barriers to physician care and improve integration across health and social services. (Copyright © 2022 the College of Family Physicians of Canada.)
Databáze:	MEDLINE
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