High prevalence of unmet healthcare need among people who use illicit drugs in a Canadian setting with publicly-funded interdisciplinary primary care clinics

Abstract

Background: People who use illicit drugs (PWUD) experience significant barriers to healthcare. However, little is known about levels of attachment to primary care (defined as having a regular family doctor or clinic they feel comfortable with) and its association with unmet healthcare needs in this population. In a Canadian setting that features novel publicly-funded interdisciplinary primary care clinics, we sought to examine the prevalence and correlates (including attachment to primary care) of unmet healthcare needs among PWUD. Methods: Data were derived from two prospective cohort studies of PWUD in Vancouver, Canada between December 2017 and November 2018. Multivariable logistic regression was used to identify factors associated with self-reported unmet healthcare needs among participants reporting any health issues. Results: In total, 743 (83.6%) of 889 eligible participants reported attachment to primary care and 220 (24.7%) reported an unmet healthcare need. In multivariable analyses, attachment to primary care at an integrated care clinic (adjusted odds ratio [AOR] = 0.14; 95% Confidence Interval [CI]: 0.06–0.34) was negatively associated with an unmet healthcare need, while being treated poorly at a healthcare facility (AOR = 5.50; 95% CI: 3.59–8.60) and self-reported chronic pain (AOR = 2.00, 95% CI: 1.30–3.01) were positively associated with an unmet healthcare need. Conclusion: Despite the high level of attachment to primary care, a quarter of our sample reported an unmet healthcare need. Our findings suggest that multi-level interventions are required to address the unmet need, including pain management and integrated care, to support PWUD with complex health needs.

Keywords:

• Illicit drugs
• delivery of health care
• integrated
• primary care
• Canada

Acknowledgments

The authors thank the study participants for their contribution to the research, as well as current and past researchers and staff. We also thank the Vancouver Area Network of Drug Users (VANDU), the British Columbia Association for People on Opiate Maintenance (BCAPOM) and the Western Aboriginal Harm Reduction Society (WAHRS) for their contributions to the development of the 2GS Supplement questionnaires and feedback on the preliminary results.

Additional information

Funding

This study is supported by the Canadian Institutes of Health Research (CIHR) under Grant number [PJT-15924]; National Institutes of Health (NIH) under Grant numbers [U01DA038886, U01DA021525]; the Canada Research Chairs Program through a Tier 1 Canada Research Chair in Inner City Medicine which supports Dr. Evan Wood (Director of BC Center on Substance Use); and CIHR through the Canadian Research Initiative on Substance Misuse under Grant number [SMN–139148]. SM is supported by a CIHR Frederick Banting and Charles Best Canada Graduate Scholarship-Master’s (CGS-M) award. MJM is supported by a CIHR New Investigator Award, a Michael Smith Foundation for Health Research (MSFHR) Scholar Award and the US NIH under Grant number [U01-DA0251525]. His institution has received an unstructured gift from NG Biomed, Ltd., to support his research. He is the Canopy Growth professor of cannabis science at the University of British Columbia, a position established through arms’ length gifts to the university from Canopy Growth Corporation, a licensed producer of cannabis in Canada, and the Government of British Columbia’s Ministry of Mental Health and Addictions. He has no personal financial relationships to the cannabis industry. BH holds a St. Paul’s Hospital CANFAR Chair in HIV/AIDS Research and is supported by a Michael Smith Foundation for Health Research Scholar Award. KH holds the St. Paul’s Hospital Chair in Substance Use Research and is supported a CIHR New Investigator Award and a MSFHR Scholar Award. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.