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Our objective was to describe and assess the prevalence and characteristics of substance‐abusing persons without primary care physicians. We interviewed a convenience sample at one point in time. Patients/participants were persons presenting for addictions treatment in a public substance abuse treatment system. Of 5824 respondents, 41% did not have a physician. In a multivariable analysis, the following were associated with not having a physician: no health insurance [adjusted odds ratio (OR), 2.05; 95% confidence interval (CI), 1.79–2.35], no history of a chronic (OR, 1.70; CI, 1.47–1.97) or an episodic (OR, 1.20; CI, 1.05–1.39) medical illness, male gender (OR, 1.49; CI, 1.29–1.71), and younger age (by decade) (OR, 1.12; CI, 1.04–1.38). Prior addictions or mental health treatment or a recent emergency‐room visit were not significantly associated with having a physician. Many patients with addictions serious enough to prompt presentation for treatment stated that they did not have physicians. Although younger persons, males, and those without insurance or past medical illness were more likely to report not having a physician, neither prior addictions or mental health treatment nor a recent emergency‐room visit decreased this likelihood. To achieve improved linkage of substance‐abusing patients with primary medical care, all health‐care contacts should be utilized.
Notes
Preliminary data were presented at the annual meeting of the Society of General Internal Medicine, May 5, 1995, and published in abstract form in the Journal of General Internal Medicine 1995; 10 (Suppl. 2): 79.
Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
Office for Treatment Improvement, Boston, Massachusetts.
Institute for Urban Health Policy, Research and Education and Department of Health and Hospitals, Boston, Massachusetts.
To whom correspondence should be addressed at General Internal Medicine Research Unit, Boston Medical Center, 91 East Concord Street Suite 200, Boston, Massachusetts 02118.