British Columbia Centre on Substance Use, Vancouver, BC, Canada.
Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
Subst Use Addctn J. 2024 Oct;45(4):653-663. doi: 10.1177/29767342241249870. Epub 2024 May 28.
For structurally marginalized populations, including people who use drugs (PWUD), equitable access to healthcare can be achieved through healthcare access supports. However, few studies characterized utilization of formal (eg, outreach workers, healthcare professionals) and informal (eg, friends/family) supports. Therefore, we sought to estimate the prevalence of and factors associated with receiving each type of support among PWUD.
We used data from 2 prospective cohort studies of PWUD in Vancouver, Canada, in 2017 to 2020. We constructed separate multivariable generalized linear mixed-effects models to identify factors associated with receiving each of the 3 types of supports (ie, healthcare professionals, outreach workers/peer navigators, and informal supports) compared to no supports.
Of 996 participants, 350 (35.1%) reported receiving supports in the past 6 months at baseline, through informal supports (6.2%), outreach workers (14.1%), and healthcare professionals (20.9%). In multivariable analyses, HIV positivity, chronic pain, and avoiding healthcare due to the past mistreatment were positively associated with receiving supports from each of healthcare professionals and outreach workers. Men were less likely to receive any types of the supports (all < .05).
Utilization of healthcare access supports was relatively low in this sample. However, formal supports appeared to have reached PWUD exhibiting more comorbidities and experiencing discrimination in healthcare. Further efforts to make formal supports more available would benefit PWUD with unmet healthcare needs, particularly men.
对于结构上处于边缘地位的人群，包括吸毒者（PWUD），通过医疗保健准入支持，可以实现公平获得医疗保健。然而，很少有研究描述了正式（例如，外展工作者、医疗保健专业人员）和非正式（例如，朋友/家人）支持的利用情况。因此，我们试图估计 PWUD 获得每种支持的比例和相关因素。
我们使用了 2017 年至 2020 年在加拿大温哥华进行的 2 项前瞻性队列研究的 PWUD 数据。我们构建了单独的多变量广义线性混合效应模型，以确定与接受每种支持（即医疗保健专业人员、外展工作者/同伴导航员和非正式支持）相关的因素，与没有支持相比。
在 996 名参与者中，350 名（35.1%）在基线时有报告在过去 6 个月内获得支持，通过非正式支持（6.2%）、外展工作者（14.1%）和医疗保健专业人员（20.9%）。在多变量分析中，HIV 阳性、慢性疼痛和因过去受到虐待而避免医疗保健与接受医疗保健专业人员和外展工作者的支持均呈正相关。男性不太可能获得任何类型的支持（均<0.05）。
在本样本中，医疗保健准入支持的利用率相对较低。然而，正式支持似乎已经覆盖到了有更多合并症和在医疗保健中经历歧视的 PWUD。进一步努力使正式支持更加普及，将使未满足医疗保健需求的 PWUD，特别是男性受益。
