Retention in primary care among unstably housed residents of a low-income, inner-city neighborhood with a high prevalence of substance use and related disorders.
| Autor: | Gumprich, M., Zhang, W., Li, J., Salters, K., Barrios, R., Sereda, P., Stanley, C., Joe, R., Hall, D., Lima, V., Sincraian, G., Changir, A. Marante, Parry, R., Fulton, C., Wesseling, T., Montaner, J., Parashar, S., Moore, David M. |
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| Předmět: |
MORTALITY risk factors
HEALTH services accessibility SUBSTANCE abuse PATIENT compliance RESEARCH funding PRIMARY health care FISHER exact test DISEASE prevalence DESCRIPTIVE statistics CHI-squared test MANN Whitney U Test ALCOHOL-induced disorders LONGITUDINAL method HOUSING stability HEALTH care teams NEIGHBORHOOD characteristics POVERTY PROPORTIONAL hazards models MEDICAL referrals DISEASE risk factors |
| Zdroj: | International Journal for Equity in Health; 11/28/2024, Vol. 23 Issue 1, p1-9, 9p |
| Abstrakt: | Introduction: Access to and engagement with primary healthcare can be difficult for marginalized low-income populations residing in inner cities in high-income countries. We designed a study to examine retention in primary care among clients of a novel interdisciplinary primary care clinic in the Downtown Eastside of Vancouver, Canada who did not previously have access to care. Methods: Beginning in June 2021, clients of the Hope to Health clinic were offered enrolment in a cohort study which involved a baseline and follow-up surveys every six months, and linking their data to information from the clinic's electronic medical records. We used Chi-square or Fisher's Exact test and Wilcoxon rank sum test to compare clients who were lost to follow-up (LTFU) or deceased, with clients who were retained in care at the end of follow-up, Cox proportional hazards modeling was used to examine independent associations with mortality or LTFU. Results: Among 425 participants enrolled, the median age was 50 years (IQR 40–59), 286 (67.3%) participants were men and 128 (25.4%) were unstably housed at enrollment. Among 338 participants with at least six months of follow-up after enrolment, 262 participants (67.5%) were retained in care, 20 (5.2%) had moved, 57 (14.7%) were classified as LTFU, and 28 (7.2%) had died with a median of 19.9 months of follow-up time. The risk of death or LTFU was independently associated diagnosed with alcohol use disorder (AUD) (adjusted hazard ratio [AHR] = 2.23 vs. not; 1.38–3.60), frequency of medical doctor visits (AHR = 0.69 per visit per 3 months; 0.60–0.79) and social work visits (AHR = 0.73 per visit per 3 months; 0.59–0.90. Stimulant use disorder or asthma were not significantly associated with retention in care. Conclusion: We found that a primary healthcare model of care was successful in retaining over two-thirds of clients in primary healthcare after more than 18 months of follow-up. Additional supports for those diagnosed with alcohol use disorder are needed to retain them in care. [ABSTRACT FROM AUTHOR] |
| Databáze: | Complementary Index |
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