Qualitative understandings of access to primary care services for consumers who use methamphetamine

Ward, Bernadette; Lane, Riki; Quinn, Brendan; Russell, Grant

doi:10.31128/ajgp-07-20-5550

Cited by 5 publications

(9 citation statements)

References 18 publications

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“…In Australia, primary health care services play an important role in the management and/or referral for the treatment of mental illness (Cross and Hickie, 2017). Consumers who use methamphetamine report primary care services as their most common point of contact with the health care system (McKetin et al, 2018; Quinn et al, 2020), yet some primary care providers report they do not see and/or are reluctant to provide care to this population (Ward et al, 2021). Diagnoses of anxiety and/or depression may provide a segue into an integrated model of care whereby common comorbidities (e.g.…”

Section: Discussionmentioning

confidence: 99%

Correlates of anxiety and depression in a community cohort of people who smoke methamphetamine

Duncan

Kippen

Sutton

et al. 2021

Aust N Z J Psychiatry

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Objective: Anxiety and depression are the most common mental health disorders experienced by Australians. These disorders are commonly found in people who use methamphetamine; however, much of this research has involved participants recruited from treatment settings who inject methamphetamine. We therefore explored (1) the prevalence of moderate to severe anxiety and depression in a community-recruited cohort who smoked methamphetamine and (2) examined potential factors associated with moderate to severe anxiety or depression in this cohort. Method: Data were derived from baseline surveys of 725 participants of the prospective ‘VMAX’ study, recruited from metropolitan and non-metropolitan areas of Victoria, Australia, via snowball and respondent-driven sampling. Anxiety and depression were measured using the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9 instruments. Independent associations between moderate to severe scores on these measures and demographic, socio-economic, substance use and other health and social characteristics were examined using multivariable logistic regression. Results: More than half (60%) of the participants were classified as experiencing moderate to severe anxiety and/or depression. In the multivariable models, having poor/very poor self-rated health, methamphetamine dependence and being unemployed were associated with higher odds of experiencing both moderate to severe depression and moderate to severe anxiety. Living in a large rural town, identifying as Aboriginal and Torres Strait Islander and smoking methamphetamine were associated with lower odds of experiencing moderate to severe depression. Being female was associated with higher odds of experiencing moderate to severe anxiety. Conclusion: The high rates of anxiety and/or depression found in the VMAX cohort were associated with demographic, socio-economic, substance use and other health and social factors. The prevalence of moderate to severe anxiety is a novel finding that warrants further study. Further work is needed to determine how anxiety and depression change over time among people who smoke methamphetamine, to help identify key intervention points.

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Section: Discussionmentioning

confidence: 99%

Correlates of anxiety and depression in a community cohort of people who smoke methamphetamine

Duncan

Kippen

Sutton

et al. 2021

Aust N Z J Psychiatry

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“…emergency departments and psychiatric admissions); future research would benefit investigating the triggers for what motivates people who use methamphetamine and comorbidly experience anxiety or depression to seek either acute or non-acute health services for mental health, especially for those who smoke methamphetamine. Evidence from the perspective of primary healthcare providers suggest that certain dimensions of access to care need to be considered, as well as the social determinants of health (Ward et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

“…While our findings are congruent with previous studies that found increased health service use in those experiencing co-occurring depression, anxiety, and substance use (McKetin et al, 2018;Mills et al, 2012;Quinn et al, 2013), it is important to consider the multiple dimensions of service accessibility that affect people who use methamphetamine. Access to services needs to consider the availability of appropriate services for cooccurring methamphetamine use and anxiety or depression; they also need to be affordable to the consumer, approachable, and acceptable to the individual consumers' social and cultural needs (Ward et al, 2021). Addressing the helping and hindering factors associated with engagement in health service for people that use methamphetamine and experience co-occurring methamphetamine use and anxiety or depression is crucial to closing the gap for those are not seeking mental health support that may truly benefit from it.…”

Section: Discussionmentioning

confidence: 99%

“…intoxication and symptoms of withdrawal) may affect an individual's capacity to engage with health services and result in a reliance on acute services. Contact with non-acute services for mental health by people who use methamphetamine may also be affected by whether social determinants of health are addressed, as well as barriers such as poor availability and stigma (Levesque et al, 2013;Ward et al, 2021). For example, living in unstable housing, not being employed, and not finishing high school can impede capacity to engage with health services due to financial hardship (McKetin et al, 2018).…”

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confidence: 99%

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Health Service Use for Mental Health Reasons in a Cohort of People Who Use Methamphetamine Experiencing Moderate to Severe Anxiety or Depression

Duncan

Kippen

Sutton

et al. 2022

Int J Ment Health Addiction

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This study examined health service use for mental health reasons in a cohort of people who use methamphetamine and experience anxiety or depression. Data were derived from baseline surveys of a subset of 429 participants from the ‘VMAX’ study. Anxiety and depression were measured using the Generalized Anxiety Disorder-7 instruments and the Patient Health Questionnaire-9. Sequential logistic regression determined correlates of health service use for mental health reasons. Lower odds of health service use for mental health reasons were evident for those living in a medium/small rural town (aOR = 0.27, CI = 0.12, 0.62), ≥ weekly methamphetamine use (aOR = 0.51, CI = 0.27, 0.99), and not utilising professional support for methamphetamine use in the 12 months prior (aOR = 0.19, CI = 0.12, 0.30). People who use methamphetamine frequently use health services for mental health issues. Further work is needed to determine the effectiveness of these services for this population.

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“…8,12 Little is known about primary care providers' experience with the emergent "twin epidemic," particularly around practice changes within the era of the COVID-19 pandemic. 11,13 To date, only one study from Australia has explored primary care providers' perspectives on addressing methamphetamine use. 11 The sample was limited to only 8 providers in a rural area of Australia with low stimulant use rates.…”

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confidence: 99%

Addressing Methamphetamine Use in Primary Care: Provider Perspectives

et al. 2022

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IntroductionThe opioid epidemic has evolved into a combined stimulant epidemic, with escalating stimulant and fentanyl-related overdose deaths. Primary care providers are on the frontlines grappling with patients’ methamphetamine use. Although effective models exist for treating opioid use disorder in primary care, little is known about current clinical practices for methamphetamine use.MethodsSix semistructured group interviews were conducted with 38 primary care providers. Interviews focused on provider perceptions of patients with methamphetamine use problems and their care. Data were analyzed using inductive and thematic analysis and summarized along the following dimensions: (1) problem identification, (2) clinical management, (3) barriers and facilitators to care, and (4) perceived needs to improve services.ResultsPrimary care providers varied in their approach to identifying and treating patient methamphetamine use. Unlike opioid use disorders, providers reported lacking standardized screening measures and evidence-based treatments, particularly medications, to address methamphetamine use. They seek more standardized screening tools, Food and Drug Administration–approved medications, reliable connections to addiction medicine specialists, and more training. Interest in novel behavioral health interventions suitable for primary care settings was also noteworthy.ConclusionsThe findings from this qualitative analysis revealed that primary care providers are using a wide range of tools to screen and treat methamphetamine use, but with little perceived effectiveness. Primary care faces multiple challenges in effectively addressing methamphetamine use among patients singularly or comorbid with opioid use disorders, including the lack of Food and Drug Administration–approved medications, limited patient retention, referral opportunities, funding, and training for methamphetamine use. Focusing on patients’ medical issues using a harm reduction, motivational interviewing approach, and linkage with addiction medicine specialists may be the most reasonable options to support primary care in compassionately and effectively managing patients who use methamphetamines.

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Qualitative understandings of access to primary care services for consumers who use methamphetamine

Cited by 5 publications

References 18 publications

Correlates of anxiety and depression in a community cohort of people who smoke methamphetamine

Correlates of anxiety and depression in a community cohort of people who smoke methamphetamine

Health Service Use for Mental Health Reasons in a Cohort of People Who Use Methamphetamine Experiencing Moderate to Severe Anxiety or Depression

Addressing Methamphetamine Use in Primary Care: Provider Perspectives

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