Factors associated with high use of general practitioner and psychiatrist services among patients attending an addiction rehabilitation center

Abstract

BackgroundThis study aimed to 1) identify the characteristics of individuals with substance use disorders (SUDs) who make high use of services provided by general practitioners (GP) and psychiatrists while receiving services concurrently from an addiction rehabilitation center (ARC), and 2) to compare high service users to moderate and low service users.MethodsData were compiled for 4,407 individuals with SUDs who were receiving services from an ARC in 2004. The data came from the merging of four databases: the ARC data registry (January 1st, 2004–December 31, 2004), the Quebec Health Insurance Board database (March 31, 2003–April 1st, 2005), the Quebec provincial database for hospitalizations (March 31, 2003–April 1st, 2005), and the Quebec National Institute of Public Health database (2004). Independent variables were grouped according to the Andersen Behavioral Model of Health Services Use: predisposing, enabling and need factors. Generalized estimating equations analyses were performed to assess the influence of individual and neighborhood-level characteristics on high use of services outside the ARC provided by GPs and psychiatrists. Benjamini-Hochberg’s procedure was applied to correct for multiple comparisons.ResultsAbout 97 % of individuals attending the ARC consulted a GP or a psychiatrist during the two-year study period, for a mean of 1.5 consultations per month. Findings revealed that 5 % of the sample made 26 % of all consultations over the two years, and they were defined as high users. No single predisposing factor was associated with high use. One enabling factor significantly increased the risk of being a high user of services from general practitioners and psychiatrists: receiving services at the ARC for three years prior to 2004. Four needs factors, all related to mental health diagnoses (schizophrenia, mood disorder, anxiety disorder, personality disorder), predicted high use of general practitioner and psychiatrist services.ConclusionsThis study found that nearly all individuals with SUDs receiving services from an ARC were users of health services from GPs and psychiatrists outside the ARC. High users most probably accessed them in inpatient settings. No previous study has compared high service users with low and moderate users among individuals with SUDs. Considering that ARCs are treating individuals with complex needs, some of whom make high use of medical professionals, both ARCs and their clients could benefit from increased collaboration and integration between the addictions and mental healthcare sectors.

Relations between mental health team characteristics and work role performance

“…It is possible that these users require concerted action involving multiple health professionals; the strong correlation between these two user profiles is well documented in the literature. UPDs were identified as more likely to be high users of healthcare services, including primary care and specialized services [ 55 – 57 ]. A covariance emerged between network integration strategies and high users, but not between these strategies and UPDs.…”

Définir les troubles liés aux substances psychoactives à partir de données administratives

“…En revanche, même si ces individus ne consultent pas spécifiquement pour un TLS, ils demeurent néanmoins en contact avec le système médical. À titre d'exemple, 98 % des usagers du Centre de réadaptation en dépendance de Montréal, qui offre principalement des services psychosociaux, avaient eu minimalement un contact avec un médecin au cours des deux années à l'étude 57 . Ainsi, les cas non identifiés relèvent davantage d'aspects administratifs (code non posé, code alternatif à celui d'un TLS) que d'une faible demande de services de la part des usagers ou de négligence professionnelle médicale (c.-à-.d.…”

Modeling variables associated with personal recovery among service users with mental disorders using community-based services

“…Sub-model 4 revealed that more needs were positively associated with recovery when mediated by the use of food banks; yet, when mediated by number of MH professionals consulted, the relationship between total number of needs and recovery became negative. This result suggests that seeking help from multiple sources, as commonly occurs among heavy service users (Huỳnh, Ngui, Kairouz, Lesage, & Fleury, 2016), implied a lack of continuity of care and of individualized treatment planning, both antithetical to recovery-oriented service delivery (Tandon, Targum, Nasrallah, & Ross, 2006).…”