British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada; Centre for Urban Health Solutions, St Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada.
Pain Manag Nurs. 2021 Apr;22(2):133-140. doi: 10.1016/j.pmn.2020.11.008. Epub 2020 Dec 24.
The opioid overdose crisis underscores the need for health services among people who use drugs (PWUD) with concurrent pain.
Investigating the effect of pain on barriers to accessing health services among PWUD.
Prospective cohort study.
A setting of universal access to no-cost medical care in Vancouver, Canada from June 2014 to May 2016.
PARTICIPANTS/SUBJECTS: PWUD who completed at least one study interview.
Data derived from interviewer-administered questionnaires were used for multivariable generalized linear mixed-effects multiple regression (GLMM) analyses.
Among 1,348 PWUD, 469 (34.8%) reported barriers to accessing health services at least once during the study period. The median average pain severity was 3 (IQR: 0-6) out of 10. A dose-response relationship was observed between greater pain and increased odds of reporting barriers to accessing health services (adjusted odds ratio [AOR]: 1.59, 95% confidence interval [CI]: 1.15-2.21, p = .005 for mild versus no pain; AOR: 1.76, 95% CI: 1.30-2.37, p < .001 for moderate versus no pain; AOR: 2.55, 95% CI: 1.92-3.37, p < .001 for severe versus no pain). Common barriers included poor treatment by health professionals, socio-structural barriers such as transportation or mobility, and long wait lists or wait times.
Pain may be a significant risk factor associated with increased barriers to accessing health services among PWUD. Attention to pain management may improve access to health services, and reducing barriers to health services may conversely improve pain management and its related risks and harms.
阿片类药物过量危机突显了需要为同时患有疼痛的吸毒者（PWUD）提供健康服务。
调查疼痛对 PWUD 获取健康服务障碍的影响。
前瞻性队列研究。
2014 年 6 月至 2016 年 5 月，在加拿大温哥华提供免费医疗服务的普遍获取环境。
参与者/受试者：至少完成一次研究访谈的 PWUD。
使用访谈者管理的问卷数据进行多变量广义线性混合效应多项回归（GLMM）分析。
在 1348 名 PWUD 中，469 名（34.8%）在研究期间至少报告过一次获取健康服务的障碍。平均疼痛严重程度中位数为 3（IQR：0-6）。在疼痛程度与报告获取健康服务障碍的几率之间观察到剂量反应关系（调整后的优势比 [AOR]：1.59，95%置信区间 [CI]：1.15-2.21，p =.005 轻度与无疼痛相比；AOR：1.76，95% CI：1.30-2.37，p <.001 中度与无疼痛相比；AOR：2.55，95% CI：1.92-3.37，p <.001 严重与无疼痛相比）。常见的障碍包括卫生专业人员的治疗不当、交通或行动不便等社会结构障碍以及漫长的等待名单或等待时间。
疼痛可能是 PWUD 获得健康服务障碍增加的一个重要危险因素。关注疼痛管理可能会改善健康服务的获取，而减少健康服务的障碍可能会反过来改善疼痛管理及其相关的风险和危害。
