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Garpenhag L, Dahlman D. Barriers to and facilitators of screening for cervical and breast cancer: Experiences of non-adherent women with current or previous drug use. Prev Med Rep 2024; 39:102641. [PMID: 38370982 PMCID: PMC10869932 DOI: 10.1016/j.pmedr.2024.102641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/20/2024] Open
Abstract
Objective Women with current or previous drug use (WCPDU) have an increased risk of poor cervical and breast cancer outcomes, and low participation in screening for these cancer forms. The aim of this study was to assess self-reported barriers to and facilitators of cervical and breast cancer screening, among WCPDU. Methods A survey based on results from a previous qualitative study about WCPDUs experiences of cancer screening was distributed to WCPDU at six opioid agonist treatment (OAT) clinics and one needle exchange program (NEP) in Malmö, Sweden, and through the Drug Users Union in Stockholm, Sweden. Data on barriers to and facilitators of cancer screening reported by 222 non-adherent WCPDU was analyzed by descriptive statistics. The barriers were structured according to an established model of healthcare access. Results The most frequently reported barriers to cervical as well as breast cancer screening were non-receipt of screening invitations (36 % and 25 %, respectively), trouble remembering the appointment (27 % and 30 %) and other priorities (26 % and 29 %). Common suggested facilitators for both cervical and breast cancer screening were screening access at, e.g., a NEP or OAT clinic (45 % and 40 %) and practical support to attend the screening appointment (40 % and 38 %). Conclusions In contrast to general population women, WCPDU report mainly practical barriers to cervical and breast cancer screening. However, NEP participants frequently reported experience of stigma and poor reception as barriers to screening. Interventions to minimize barriers to screening are crucial to decrease the increased cancer morbidity and mortality among WCPDU.
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Affiliation(s)
- Lars Garpenhag
- Center for Primary Health Care Research, Department of Clinical Sciences, Clinical Research Center/CRC, Lund University/Region Skåne, Box 503 22, Malmö, Sweden
- Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, BMC I12, 221 84 Lund, Sweden
| | - Disa Dahlman
- Center for Primary Health Care Research, Department of Clinical Sciences, Clinical Research Center/CRC, Lund University/Region Skåne, Box 503 22, Malmö, Sweden
- Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, BMC I12, 221 84 Lund, Sweden
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Rajab D, Fujioka JK, Walker M, Bartels SA, MacKenzie M, Purkey E. Emergency department care experiences among people who use substances: a qualitative study. Int J Equity Health 2023; 22:248. [PMID: 38049838 PMCID: PMC10696685 DOI: 10.1186/s12939-023-02050-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/02/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND People who use substances (PWUS) encounter significant barriers to accessing care for their complex health needs. As a result, emergency departments (EDs) often become the first point of healthcare access for many PWUS and are a crucial setting for the study of health inequities. This study aimed to understand the ED healthcare experiences of PWUS with the intent of informing ways of improving the delivery of equitable care. METHODS This qualitative study was part of a larger cross-sectional, mixed-methods study that examined ED experiences among diverse underserved and equity-deserving groups (EDGs) within Kingston, Ontario, Canada. Participants shared and self-interpreted a story about a memorable ED or UCC visit within the preceding 24 months. Data from participants who self-identified as having substance use experiences was analyzed through inductive thematic analysis. RESULTS Of the 1973 unique participants who completed the survey, 246 participants self-identified as PWUS and were included in the analysis. Most participants were < 45 years of age (61%), male (53%), and white/European (57%). 45% identified as a person with a disability and 39% frequently struggled to make ends meet. Themes were determined at the patient, provider, and system levels. PATIENT history of substance use and experience of intersectionality negatively influenced participants' anticipation and perception of care. Provider: negative experiences were linked to assumption making, feelings of stigma and discrimination, and negative perceptions of provider care. Whereas positive experiences were linked to positive perceptions of provider care. System: timeliness of care and the perception of inadequate mental health resources negatively impacted participants' care experience. Overall, these themes shaped participants' trust of ED staff, their desire to seek care, and their perception of the care quality received. CONCLUSIONS PWUS face significant challenges when seeking care in the ED. Given that EDs are a main site of healthcare utilization, there is an urgent need to better support staff in the ED to improve care experiences among PWUS. Based on the findings, three recommendations are proposed: (1) Integration of an equity-oriented approach into the ED, (2) Widespread training on substance use, and (3) Investment in expert resources and services to support PWUS.
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Affiliation(s)
- Dana Rajab
- Department of Medicine, Queen's University, Kingston, ON, Canada.
| | - Jamie K Fujioka
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Melanie Walker
- Department of Medicine, Queen's University, Kingston, ON, Canada
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Susan A Bartels
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Meredith MacKenzie
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
- Street Health Centre, Kingston Community Health Centres, Kingston, ON, Canada
| | - Eva Purkey
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
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3
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Garpenhag L, Dahlman D. Screening for breast and cervical cancer among OST patients: a qualitative study of barriers and suggested interventions to increase participation. Int J Qual Stud Health Well-being 2023; 18:2175767. [PMID: 36756664 PMCID: PMC9930823 DOI: 10.1080/17482631.2023.2175767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
PURPOSE Women with current or previous drug use are at risk of poor breast and cervical cancer outcomes. While screening is known to decrease cancer mortality, screening participation is sparsely investigated among drug dependent women. The aim of this study was to explore experiences of breast and cervical cancer screening-including barriers and suggested interventions to promote increased participation-among women in opioid substitution treatment (OST). METHODS Three focus group interviews were conducted at one OST clinic in Malmö, Sweden. The interviews were moderated by OST staff, assisted by a researcher. A descriptive qualitative analysis was carried out using a template analysis approach, employing a model of healthcare access to organize the description of barriers. RESULTS The 11 participants reported several barriers to screening access, affecting the perceived need of screening and the opportunities to seek and reach screening services. Some barriers appear to be specific to women with previous or current drug use. Suggested interventions were moral and practical support, integrated/specialized delivery of screening services, and enhanced screening invitation procedures. CONCLUSIONS The study findings provide insight to difficulties with screening compliance among women with current or previous drug use, and provide a knowledge base for quantitative and intervention studies.
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Affiliation(s)
- Lars Garpenhag
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University/Region Skåne, Malmö, Sweden,CONTACT Lars Garpenhag Clinical Research Center, Centrum för primärvårdsforskning, Box 50322, 202 13, Malmö, Sweden
| | - Disa Dahlman
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University/Region Skåne, Malmö, Sweden,Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
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Reichert J, del Pozo B, Taylor B. Police Stigma toward People with Opioid Use Disorder: A Study of Illinois Officers. Subst Use Misuse 2023; 58:1493-1504. [PMID: 37365862 PMCID: PMC10529704 DOI: 10.1080/10826084.2023.2227698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
BackgroundFatal opioid overdoses continue to break historical records. Stigma toward people with opioid use disorder (OUD) can negatively impact treatment access, retention, and recovery. Attitudes and beliefs of police officers can profoundly shape key discretionary decisions. Therefore, we examined police officer views indicating stigma toward those with OUD.ObjectivesWe administered an online survey to select Illinois police departments using a stratified random sampling strategy with a final sample of 248 officers from 27 police departments. We asked officers questions measuring stigmatizing attitudes toward people with OUD including distrust, blame, shame, and fear. We found officers held somewhat stigmatizing views with a mean score of 4.0 on a scale of 1 (least stigmatic) to 6 (most stigmatic).ResultsRegression results showed certain officer characteristics were associated with more stigmatizing attitudes of blaming and distrust of those with OUD, including gender, education, race, years in policing, and department size.Conclusions/ImportanceSince most officers in the sample held at least some stigmatizing views toward people with OUD, this may impede the feasibility and acceptability of criminal justice interventions meant to improve behavioral health, such as police deflection programs that link people who use drugs to treatment in lieu of arrest. Departments should offer officer training and education on substance use disorders, treatment for addiction, and the potential for a person's recovery. Training should allow officers to hear directly from, or learn about, personal experiences of people who use drugs and have been in recovery, as this type of interaction has been shown to reduce stigma.
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Affiliation(s)
- Jessica Reichert
- Center for Justice Research and Evaluation, Illinois Criminal Justice Information Authority, Chicago, Illinois, USA
| | - Brandon del Pozo
- Division of General Internal Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- The Miriam Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Bruce Taylor
- NORC at the University of Chicago, Public Health Department, Chicago, Illinois, USA
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Farrugia A, Pienaar K, Fraser S, Edwards M, Madden A. Basic care as exceptional care: addiction stigma and consumer accounts of quality healthcare in Australia. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2021; 30:95-110. [PMID: 34018910 DOI: 10.1080/14461242.2020.1789485] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/14/2020] [Indexed: 05/25/2023]
Abstract
The discrimination faced by people understood to have alcohol or other drug addictions has been the subject of extensive research, with many studies documenting experiences of stigma within healthcare services. Building on this literature, we examine the role of stigma in shaping the healthcare expectations of people seen as affected by alcohol and other drug addictions. Our analysis draws on recent theorisations of stigma as a process of social production to analyse in-depth, qualitative interviews with 20 people who had recently attended an inpatient withdrawal management service. Participants describe as exceptional forms of care that are often taken for granted by other members of the community. We argue that routinised experiences of discrimination work to constitute basic care as exceptional. This finding is significant for two reasons: (1) people who consume alcohol and other drugs often have complex healthcare needs and already encounter obstacles to accessing the care they need, and (2) by positioning people who consume drugs outside the purview of healthcare, this dynamic obstructs their fundamental right to care. We conclude by reflecting on the implications of these findings for those who are often positioned as not entitled to high quality healthcare.
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Affiliation(s)
- Adrian Farrugia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia
- National Drug Research Institute, Curtin University, Australia
| | - Kiran Pienaar
- Sociology, School of Humanities and Social Sciences, Faculty of Arts and Education, Deakin University, Australia
- Sociology, School of Social Sciences, Faculty of Arts, Monash University, Australia
| | - Suzanne Fraser
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Australia
| | - Michael Edwards
- National Drug and Alcohol Research Centre, School of Medicine, University of New South Wales, Australia
| | - Annie Madden
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Australia
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Miller-Lloyd L, Landry J, Macmadu A, Allard I, Waxman M. Barriers to Healthcare for People Who Inject Drugs: A Survey at a Syringe Exchange Program. Subst Use Misuse 2020; 55:896-899. [PMID: 31902293 DOI: 10.1080/10826084.2019.1710207] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Despite research demonstrating increased need for healthcare services among people who use drugs, few studies have investigated barriers to general healthcare in this population. We explored the most common barriers to general healthcare faced by clients utilizing syringe access services. Methods: Clients of Project Safe Point- a syringe access service serving Albany, NY and surrounding regions-were surveyed on their general health practices and specific health care barriers. Descriptive analyses were used to identify which barriers were most prevalent. Results: Of the clients surveyed (n = 59), the most common specific barriers were deprioritization of medical care (i.e., procrastination [80%], finding it easier to ignore the problem [63%]), cost (i.e., not having insurance [59%], not being able to afford the cost of care [58%]), transportation (53%), and judgement by clinicians (53%). When participants were asked to choose which was their biggest barrier to healthcare, judgement by clinicians was chosen more than twice as often as any other barrier. Conclusion: While people who inject drugs at a syringe access program often experience traditional barriers to healthcare (i.e., logistical barriers, procrastination), nearly a quarter of the clients reported feeling judged by clinicians as their most significant barrier. Future work in this field should explore interventions that motivate clients to seek care and that reduce stigma in healthcare interactions.
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Affiliation(s)
| | | | - Alexandria Macmadu
- The Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, Rhode Island, USA
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Szelest I, Motluk L, Jennens H, Lagassé J, Tailleur M, Salvalaggio G. Technology to support relational care for people who use drugs at home: Literature review and key informant content. Healthc Manage Forum 2019; 32:213-217. [PMID: 31091991 DOI: 10.1177/0840470419836266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Canada's opioid crisis is a public health emergency that disproportionately affects people who use drugs alone at home, requiring the mobilization of health systems to implement timely, effective, and innovative programs. The purpose of this review is to provide a synthesis of recent literature relating to technology-enabled harm reduction strategies. The results of the literature review are corroborated with key informants, including family members of people who use drugs and policy-makers in the area of opioid use. Based on this, it is recommended that technology-enabled support programs for people who use drugs at home must deliver support at whatever point the person is along their drug use continuum, must transfer frontline relational skills, must be co-developed with community members and service providers, and must deliver predictable and reliable services that are safe from stigma.
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Affiliation(s)
- Izabela Szelest
- 1 South Okanagan Similkameen Division of Family Practice, Penticton, British Columbia, Canada
| | - Lori Motluk
- 2 North & South Okanagan Hospitals and Community Integrated Services, Interior Health, Penticton, British Columbia, Canada
| | - Helen Jennens
- 3 Moms Stop the Harm, Kelowna, British Columbia, Canada
| | - Jeannine Lagassé
- 4 Nova Scotia Department of Health and Wellness, Office of the Associate Deputy Minister, Halifax, Nova Scotia, Canada
| | - Martin Tailleur
- 5 Strategic Information Management Technology Services Branch, Alberta Health, Edmonton, Alberta, Canada
| | - Ginetta Salvalaggio
- 6 Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
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Moravac CC. Reflections of Homeless Women and Women with Mental Health Challenges on Breast and Cervical Cancer Screening Decisions: Power, Trust, and Communication with Care Providers. Front Public Health 2018; 6:30. [PMID: 29600243 PMCID: PMC5863503 DOI: 10.3389/fpubh.2018.00030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/29/2018] [Indexed: 11/13/2022] Open
Abstract
This study conducted in Toronto, Canada, explored the perceptions of women living in homeless shelters and women with severe mental health challenges about the factors influencing their decision-making processes regarding breast and cervical cancer screening. Twenty-six in-depth qualitative interviews were conducted. The objectives of this research were (i) to provide new insights about women's decision-making processes, (ii) to describe the barriers to and facilitators for breast and cervical cancer screening, and (iii) to offer recommendations for future outreach, education, and screening initiatives developed specifically for under/never-screened marginalized women living in urban centers. This exploratory study utilized thematic analysis to broaden our understanding about women's decision-making processes. A constructed ontology was used in an attempt to understand and describe participants' constructed realities. The epistemological framework was subjective and reflected co-created knowledge. The approach was hegemonic, values-based, and context-specific. The aim of the analysis was to focus on meanings and actions with a broader view to identify the interplay between participants' narratives and social structures, medical praxis, and policy implications. Results from 26 qualitative interviews conducted in 2013-2014 provided insights on both positive and negative prior cancer screening experiences, the role of power and trust in women's decision-making, and areas for improvement in health care provider/patient interactions. Outcomes of this investigation contribute to the future development of appropriately designed intervention programs for marginalized women, as well as for sensitivity training for health care providers. Tailored and effective health promotion strategies leading to life-long cancer screening behaviors among marginalized women may improve clinical outcomes, decrease treatment costs, and save lives.
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Understanding experiences of and rationales for sharing crack-smoking equipment: A qualitative study with persons who smoke crack in Montréal. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 48:18-26. [DOI: 10.1016/j.drugpo.2017.05.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 03/20/2017] [Accepted: 05/30/2017] [Indexed: 11/22/2022]
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10
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Nambiar D, Stoové M, Hickman M, Dietze P. A prospective cohort study of hospital separations among people who inject drugs in Australia: 2008-2013. BMJ Open 2017; 7:e014854. [PMID: 28821513 PMCID: PMC5724200 DOI: 10.1136/bmjopen-2016-014854] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Injecting drug use is a persistent behaviour that increases the risk of morbidities and mortality. We assessed the burden of hospital separations among people who inject drugs (PWID), the excess compared to the general population and characteristics of separations associated with frequent use. DESIGN Prospective cohort study. SETTING All public and private hospitals in Victoria. PARTICIPANTS 757 community-based PWID with hospital separations between January 2008 and June 2013 identified through record linkage, who contributed over 3729 person-years. PRIMARY AND SECONDARY OUTCOME MEASURES Counts, proportions and rates of hospital separations, descriptive administrative data including all diagnoses, comparison of separation rates to the general population, trend in separations and factors associated with frequent separations. RESULTS There were 2106 separations in the cohort. The most common principal diagnoses were related to mental and behavioural disorders (31%), but social circumstances influencing health was the most common group of diagnoses (61%) when all contributing diagnoses for each patient were considered. Separation rates were up to three times higher than in the age-matched population, and there was a 12% increase in separations every 6 months. Over a quarter (29%) of the cohort had frequent separations (defined as two or more separations in a calendar year), which were associated with mental health-related diagnoses, being discharged to locations other than a patient's residence, having a medical as opposed to surgical intervention, seasonal patterns, relationship status and gender. CONCLUSIONS Mental health conditions and other characteristics associated with separations and frequent separations in particular, emphasise the importance of providing referrals to harm reduction, social services and mental health services at discharge in order to reduce excess hospital separations among PWID.
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Affiliation(s)
- Dhanya Nambiar
- Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Mark Stoové
- Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Paul Dietze
- Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia
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11
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LENHARD JOHANNES. You Care More for the Gear Than the Geezer? Care Relationships of Homeless Substance Users in London. CITY & SOCIETY 2017. [DOI: 10.1111/ciso.12128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Nambiar D, Stoové M, Dietze P. Frequent emergency department presentations among people who inject drugs: A record linkage study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 44:115-120. [PMID: 28511107 DOI: 10.1016/j.drugpo.2017.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/14/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND People who inject drugs (PWID) have been described as frequent users of health services such as emergency departments (EDs), however few studies have described demographic factors, patterns of substance use and previous health service use associated with frequent use of EDs in this population. METHODS Using a combination of self-reported data from a cohort of PWID and administrative ED data obtained through record linkage, we identified longitudinal factors associated with the use of ED services. Bivariate and multivariate analyses were conducted using negative binomial regression to identify exposures associated with both cumulative ED presentations, and logistic regression to identify exposures of frequent ED presentations (defined as three or more annual presentations). RESULTS Among 612 PWID, over half (58%) presented to EDs at least once and over a third (36%) presented frequently between January 2008 and June 2013. Frequent and cumulative ED presentations were associated with reporting the main drug of choice as cannabis (AOR:1.42, 95%CI:1.07-1.89 and AIRR:2.96, 95%CI:1.44-6.07 respectively) or methamphetamine (AOR:1.62, 95%CI:1.17-2.2 and AIRR:2.42, 95%CI:1.08-5.46 respectively) compared to heroin, and past month use of mental health (AOR:1.42, 95%CI:1.08-1.85 and AIRR:3.32, 95%CI:1.69-6.53 respectively) and outpatient services (AOR:1.47, 95%CI: 1.00-2.16 and AIRR:0.95, 95%CI 1.52-10.28 respectively). CONCLUSION PWID who are frequent users of EDs are likely to have complex health and substance use-related needs. EDs should actively refer people who present with cannabis and methamphetamine dependence to harm reduction services. Harm reduction services should ensure people referred from EDs are screened for co-occurring mental health conditions and receive adequate support.
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Affiliation(s)
- Dhanya Nambiar
- Centre for Population Health, Burnet Institute, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Australia.
| | - Mark Stoové
- Centre for Population Health, Burnet Institute, Australia
| | - Paul Dietze
- Centre for Population Health, Burnet Institute, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Australia
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13
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Collins KM, Armenta RF, Cuevas-Mota J, Liu L, Strathdee SA, Garfein RS. Factors associated with patterns of mobile technology use among persons who inject drugs. Subst Abus 2016; 37:606-612. [PMID: 27092425 DOI: 10.1080/08897077.2016.1176980] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND New and innovative methods of delivering interventions are needed to further reduce risky behaviors and increase overall health among persons who inject drugs (PWID). Mobile health (mHealth) interventions have potential for reaching PWID; however, little is known about mobile technology use (MTU) in this population. In this study, the authors identify patterns of MTU and identified factors associated with MTU among a cohort of PWID. METHODS Data were collected through a longitudinal cohort study examining drug use, risk behaviors, and health status among PWID in San Diego, California. Latent class analysis (LCA) was used to define patterns of MTU (i.e., making voice calls, text messaging, and mobile Internet access). Multinomial logistic regression was then used to identify demographic characteristics, risk behaviors, and health indicators associated with mobile technology use class. RESULTS In LCA, a 4-class solution fit the data best. Class 1 was defined by low MTU (22%, n = 100); class 2, by PWID who accessed the Internet using a mobile device but did not use voice or text messaging (20%, n = 95); class 3, by primarily voice, text, and connected Internet use (17%, n = 91); and class 4, by high MTU (41%, n = 175). Compared with low MTU, high MTU class members were more likely to be younger, have higher socioeconomic status, sell drugs, and inject methamphetamine daily. CONCLUSION The majority of PWID in San Diego use mobile technology for voice, text, and/or Internet access, indicating that rapid uptake of mHealth interventions may be possible in this population. However, low ownership and use of mobile technology among older and/or homeless individuals will need to be considered when implementing mHealth interventions among PWID.
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Affiliation(s)
- Kelly M Collins
- a Division of Global Public Health, School of Medicine, University of California San Diego , San Diego , California , USA
| | - Richard F Armenta
- a Division of Global Public Health, School of Medicine, University of California San Diego , San Diego , California , USA
| | - Jazmine Cuevas-Mota
- a Division of Global Public Health, School of Medicine, University of California San Diego , San Diego , California , USA
| | - Lin Liu
- b Division of Family Medicine and Public Health, School of Medicine, University of California San Diego , San Diego , California , USA
| | - Steffanie A Strathdee
- a Division of Global Public Health, School of Medicine, University of California San Diego , San Diego , California , USA
| | - Richard S Garfein
- a Division of Global Public Health, School of Medicine, University of California San Diego , San Diego , California , USA
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14
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Artenie AA, Jutras-Aswad D, Roy É, Zang G, Bamvita JM, Lévesque A, Bruneau J. Visits to primary care physicians among persons who inject drugs at high risk of hepatitis C virus infection: room for improvement. J Viral Hepat 2015; 22:792-9. [PMID: 25586516 DOI: 10.1111/jvh.12393] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 12/09/2014] [Indexed: 12/25/2022]
Abstract
The role of primary care physicians (PCP) in hepatitis C virus (HCV) prevention is increasingly emphasized. Yet, little is known about the patterns of contacts with PCP among persons who inject drugs (PWID). We sought to assess the 6-month prevalence of PCP visiting among PWID at risk of HCV infection and to explore the associated factors. Baseline data were collected from HCV-seronegative PWID recruited in HEPCO, an observational Hepatitis Cohort study (2004-2011) in Montreal, Canada. An interviewer-administered questionnaire elicited information on socio-demographic factors, drug use patterns and healthcare services utilization. Blood samples were tested for HCV antibodies. Using the Gelberg-Andersen Behavioral Model, hierarchical logistic regression analyses were conducted to identify predisposing, need and enabling factors associated with PCP visiting. Of the 349 participants (mean age = 34; 80.8% male), 32.1% reported visiting a PCP. In the multivariate model, among predisposing factors, male gender [adjusted odds ratio (AOR) = 0.45 (0.25-0.83)], chronic homelessness [AOR = 0.08 (0.01-0.67)], cocaine injection [AOR = 0.46 (0.28-0.76)] and reporting greater illegal or semi-legal income [AOR = 0.48 (0.27-0.85)] were negatively associated with PCP visits. Markers of need were not associated with the outcome. Among enabling factors, contact with street nurses [AOR = 3.86 (1.49-9.90)] and food banks [AOR = 2.01 (1.20-3.37)] was positively associated with PCP visiting. Only one third of participating PWID reported a recent visit to a PCP. While a host of predisposing factors seems to hamper timely contacts with PCP among high-risk PWID, community-based support services may play an important role in initiating dialogue with primary healthcare services in this population.
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Affiliation(s)
- A A Artenie
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Department of Family Medicine, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - D Jutras-Aswad
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Department of Psychiatry, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - É Roy
- Addiction Research and Study Program, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada.,Montréal Public Health Department, Agence de la santé et des services sociaux de Montréal, Montréal, QC, Canada
| | - G Zang
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - J-M Bamvita
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - A Lévesque
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Department of Family Medicine, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - J Bruneau
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Department of Family Medicine, Faculty of Medicine, McGill University, Montréal, QC, Canada.,Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
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Vanderplasschen W, Naert J, Vander Laenen F, De Maeyer J. Treatment satisfaction and quality of support in outpatient substitution treatment: opiate users’ experiences and perspectives. DRUGS-EDUCATION PREVENTION AND POLICY 2014. [DOI: 10.3109/09687637.2014.981508] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Lang K, Neil J, Wright J, Dell CA, Berenbaum S, El-Aneed A. Qualitative investigation of barriers to accessing care by people who inject drugs in Saskatoon, Canada: perspectives of service providers. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2013; 8:35. [PMID: 24079946 PMCID: PMC3850796 DOI: 10.1186/1747-597x-8-35] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 09/17/2013] [Indexed: 11/20/2022]
Abstract
Background People who inject drugs (PWID) often encounter barriers when attempting to access health care and social services. In our previous study conducted to identify barriers to accessing care from the perspective of PWIDs in Saskatoon, Canada: poverty, lack of personal support, discrimination, and poor knowledge and coordination of service providers among other key barriers were identified. The purpose of the present investigation was to explore what service providers perceive to be the greatest barriers for PWIDs to receive optimal care. This study is an exploratory investigation with a purpose to enrich the literature and to guide community action. Methods Data were collected through focus groups with service providers in Saskatoon. Four focus groups were held with a total of 27 service providers. Data were transcribed and qualitative analysis was performed. As a result, concepts were identified and combined into major themes. Results Four barriers to care were identified by service providers: inefficient use of resources, stigma and discrimination, inadequate education and the unique and demanding nature of PWIDs. Participants also identified many successful services. Conclusion The results from this investigation suggest poor utilization of resources, lack of continuing education of health care providers on addictions and coping skills with such demanding population, and social stigma and disparity. We recommend improvements in resource utilization through, for example, case management. In addition, sensitivity training and more comprehensive service centers designed to meet PWID’s complex needs may improve care. However, community-wide commitment to addressing injection drug issues will also be required for lasting solutions.
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Affiliation(s)
- Katherine Lang
- College of Pharmacy and Nutrition, University of Saskatchewan, Thorvaldson Building, 110 Science Place, Saskatoon, SK S7N 5C9, Canada.
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Defining a service for people who use drugs as ‘low-threshold’: What should be the criteria? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 24:220-2. [DOI: 10.1016/j.drugpo.2013.03.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 02/18/2013] [Accepted: 03/04/2013] [Indexed: 11/21/2022]
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18
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Janulis P, Ferrari JR, Fowler P. Understanding public stigma toward substance dependence. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2013. [DOI: 10.1111/jasp.12070] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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19
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Islam MM, Topp L, Iversen J, Day C, Conigrave KM, Maher L. Healthcare utilisation and disclosure of injecting drug use among clients of Australia's needle and syringe programs. Aust N Z J Public Health 2013; 37:148-54. [DOI: 10.1111/1753-6405.12032] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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20
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Salvalaggio G, Dong K, Vandenberghe C, Kirkland S, Mramor K, Brown T, Taylor M, McKim R, Cummings GG, Wild TC. Enhancing screening, brief intervention, and referral to treatment among socioeconomically disadvantaged patients: study protocol for a knowledge exchange intervention involving patients and physicians. BMC Health Serv Res 2013; 13:108. [PMID: 23517813 PMCID: PMC3610268 DOI: 10.1186/1472-6963-13-108] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 03/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Screening, Brief Intervention, and Referral for Treatment (SBIRT) is an effective approach for managing alcohol and other drug misuse in primary care; however, uptake into routine care has been limited. Uptake of SBIRT by healthcare providers may be particularly problematic for disadvantaged populations exhibiting alcohol and other drug problems, and requires creative approaches to enhance patient engagement. This knowledge translation project developed and evaluated a group of patient and health care provider resources designed to enhance the capacity of health care providers to use SBIRT and improve patient engagement with health care. METHODS/DESIGN A nonrandomized, two-group, pre-post, quasi-experimental intervention design was used, with baseline, 6-, and 12-month follow-ups. Low income patients using alcohol and other drugs and who sought care in family medicine and emergency medicine settings in Edmonton, Canada, along with physicians providing care in these settings, were recruited. Patients and physicians were allocated to the intervention or control condition by geographic location of care. Intervention patients received a health care navigation booklet developed by inner city community members and also had access to an experienced community member for consultation on health service navigation. Intervention physicians had access to online educational modules, accompanying presentations, point of care resources, addiction medicine champions, and orientations to the inner city. Resource development was informed by a literature review, needs assessment, and iterative consultation with an advisory board and other content experts. Participants completed baseline and follow-up questionnaires (6 months for patients, 6 and 12 months for physicians) and administrative health service data were also retrieved for consenting patients. Control participants were provided access to all resources after follow-up data collection was completed. The primary outcome measure was patient satisfaction with care; secondary outcome measures included alcohol and drug use, health care and addiction treatment use, uptake of SBIRT strategies, and physician attitudes about addiction. DISCUSSION Effective knowledge translation requires careful consideration of the intended knowledge recipient's context and needs. Knowledge translation in disadvantaged settings may be optimized by using a community-based participatory approach to resource development that takes into account relevant patient engagement issues. TRIAL REGISTRATION Northern Alberta Clinical Trials and Research Centre #30094.
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Affiliation(s)
- Ginetta Salvalaggio
- Department of Family Medicine, University of Alberta, 1702 College Plaza, Edmonton, AB, T6G 2C8, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, Room 565 CSC, Royal Alexandra Hospital, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9, Canada
| | | | - Scott Kirkland
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Taryn Brown
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Marliss Taylor
- Streetworks, 10116-105 Ave, Edmonton, AB, T0B 4J0, Canada
| | - Robert McKim
- Edmonton South Side and Edmonton West Primary Care Networks, Edmonton, AB, Canada
| | - Greta G Cummings
- Faculty of Nursing, 5–110 ECHA, University of Alberta, Edmonton, AB, T6G 0C1, Canada
| | - T Cameron Wild
- School of Public Health, 3–277 ECHA, University of Alberta, Edmonton, AB, T6G 2G4, Canada
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Lang K, El-Aneed A, Berenbaum S, Dell CA, Wright J, McKay ZT. Qualitative assessment of crisis services among persons using injection drugs in the city of Saskatoon. JOURNAL OF SUBSTANCE USE 2011. [DOI: 10.3109/14659891.2011.606350] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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De Maeyer J, Vanderplasschen W, Camfield L, Vanheule S, Sabbe B, Broekaert E. A good quality of life under the influence of methadone: a qualitative study among opiate-dependent individuals. Int J Nurs Stud 2011; 48:1244-57. [PMID: 21481390 DOI: 10.1016/j.ijnurstu.2011.03.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 03/17/2011] [Accepted: 03/19/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND Attention from researchers and health care workers to the quality of life (QoL) of opiate users is growing, but most studies are quantitative, giving limited attention to the consumer's perspective. No information is available on how opiate-dependent individuals themselves perceive QoL and what they see as the important components that contribute to a good QoL. OBJECTIVES This qualitative study aims to expand our knowledge concerning opiate-dependent individuals' perceptions of a good QoL and the impact of methadone on components of a good QoL. METHODS In-depth interviews were conducted with 25 opiate-dependent individuals aged between 26 and 46 years old who started a methadone maintenance treatment at least 5 years ago. Purposive sampling was used to recruit participants with different socio-demographic characteristics and drug use profiles. The interviews were audio-tape recorded, transcribed verbatim and analysed thematically. RESULTS Thematic analyses revealed five key themes contributing to a good QoL for opiate-dependent individuals: (1) having social relationships, (2) holding an occupation, (3) feeling good about one's self, (4) being independent and (5) having a meaningful life. Opiate-dependent individuals valued methadone's ability to help them function normally, overcome their psychological problems and dependence on illicit opiates, and support them in achieving certain life goals. On the other hand, stigmatisation, discrimination, dependence on methadone and the drug's paralysing effects on their emotions were mentioned as common negative consequences. CONCLUSIONS The findings of this study highlight the importance of supporting opiate-dependent individuals in their daily life by means of practical, social and environmental support (alongside pharmacological treatment) in order to improve their QoL. This study further illustrates the ambivalent influence of methadone on opiate-dependent individuals' QoL, and demonstrates how something commonly perceived as a 'good' can also be a 'bad' for some people. Efforts should be made to limit the negative consequences of methadone on opiate-dependent individuals' QoL, while increasing its potential benefits.
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SMALL WILL, VAN BOREK NATASHA, FAIRBAIRN NADIA, WOOD EVAN, KERR THOMAS. Access to health and social services for IDU: The impact of a medically supervised injection facility. Drug Alcohol Rev 2009; 28:341-6. [DOI: 10.1111/j.1465-3362.2009.00025.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Accessing care for injection-related infections through a medically supervised injecting facility: a qualitative study. Drug Alcohol Depend 2008; 98:159-62. [PMID: 18650034 DOI: 10.1016/j.drugalcdep.2008.05.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 05/29/2008] [Accepted: 05/30/2008] [Indexed: 02/06/2023]
Abstract
Injection drug users (IDU) experience complex barriers to accessing primary medical care which may result in over reliance on emergency health services. Supervised injecting facilities (SIF) aim to address HIV and overdose risks, as well as improve access to primary medical care among IDU. This study sought to investigate IDU perspectives regarding the impact of SIF on access to care and treatment of injection-related infections. Semi-structured qualitative interviews were conducted with 50 individuals recruited from a cohort of SIF users known as the Scientific Evaluation of Supervised Injecting (SEOSI). Audio-recorded interviews were transcribed verbatim and a thematic analysis was conducted. IDU narratives indicate the availability of on-site nursing attention at the SIF facilitated uptake of health services. IDU reported that the facility provided assessment and care of injection-related infections, as well as enhanced access to off-site medical services. The presence of professional nursing personnel within a sanctioned drug consumption setting serves to address social and structural barriers that often impede IDU access to health care. This study emphasizes that the facility enables contact with the healthcare system and thereby helps to facilitate the management of injection-related infections.
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Neale J, sheard L, Tompkins CNE. Factors that help injecting drug users to access and benefit from services: A qualitative study. Subst Abuse Treat Prev Policy 2007; 2:31. [PMID: 17971204 PMCID: PMC2169215 DOI: 10.1186/1747-597x-2-31] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Accepted: 10/30/2007] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND International research shows that injecting drug users (IDUs) can encounter many barriers when they try to access drug treatment and other services. However, the existing literature is mostly quantitative and does not consider the kinds of factors that injectors themselves identify as enabling them to access and benefit from services. Responding to this gap in knowledge, our paper explores IDUs' own suggestions for improving service engagement and their reports of other factors enabling them to seek help. METHODS Semi-structured qualitative interviews were conducted with 75 current illicit drug injectors in three geographically diverse areas of West Yorkshire, England. Recruitment was through needle exchange programmes, with additional snowball sampling to ensure inclusivity of gender, ethnicity and primary drug injected. Transcribed data were analysed thematically using Framework. RESULTS Although participants were often satisfied with current access to services, they made three broad suggestions for improving engagement. These were: providing more services (more providers and more forms of support); better operation of existing services (including better communication systems and more flexibility around individual needs); and staffing-related improvements (particularly, less judgemental and more understanding staff attitudes). Other factors identified as important enablers of help seeking were: having supporting relationships (particularly with family members); personal circumstances/life events (especially becoming a parent); and an injector's state of mind (such as feeling motivated and positive). CONCLUSION A range of practical suggestions for improving IDUs' access to drug treatment and other services are identified.
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Affiliation(s)
- Joanne Neale
- Professor of Public Health, Oxford Brookes University, Oxford, UK
| | - Laura sheard
- Research Fellow, Leeds West Primary Care Trust, Leeds, UK
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Colpaert K, Vanderplasschen W, Broekaert E. Comparison of single and multiple agency clients in substance abuse treatment services. Eur Addict Res 2007; 13:156-66. [PMID: 17570912 DOI: 10.1159/000101552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Frequent and multiple service utilization among substance abusers is a well-known problem. However, little statistical evidence exists about overlapping agency populations. METHODS This phenomenon was studied in a clear-cut region in Belgium, based on intake information concerning all clients who addressed a drug treatment center within a 6-month period (n=1,139). RESULTS Multiple service utilization was rather common but not omnipresent during this particular registration period. Almost 15% of the clients were registered in more than one substance abuse treatment agency. Compared to single agency attendees, multiple agency clients appeared to be more often poly-substance abusers with a longer previous treatment history and greater problem severity. CONCLUSION A continuous care perspective, interagency collaboration and a common tracking and documentation system are recommended to better address the needs of this specific subgroup of substance abusers. More research is needed to clarify whether these multiple service utilization patterns are caused by client-related, agency-related or other factors.
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Affiliation(s)
- K Colpaert
- Department of Orthopedagogics, Ghent University, Ghent, Belgium.
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