International journal for equity in health · 2024
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.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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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
Аннотация
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.
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.