Purpose: To identify factors associated with a failure to link with primary medical care. Methods: A prospective cohort of subjects admitted for substance detoxification and without primary medical care. Linkage was defined as 1 or more primary care clinician visits in 2 years. Results: Subjects were: 76% male; mean age 36; 46% black, 37% white, 11% Hispanic; and 47% had a chronic medical illness. Most (81%) reported addictions or mental health utilization or episodic medical visits in the past 6 months. Most (87%) had polysubstance problems; 86% alcohol, 75% cocaine, 69% marijuana, and 38% heroin problems. Of 470 subjects, 348 (74%) completed a follow-up interview; 144/348 (41%) did not link with primary medical care. Insurance, psychiatric illness, addiction severity and addictions and mental health utilization were not significant predictors. In a multivariable model adjusting for age, the following were associated with a failure of linkage: male (Odds Ratio 2.6, 95% Confidence Interval 1.5-4.5), white (OR 1.7, CI 1.1-2.8), friends and family that do not support abstinence (OR 2.1, CI 1.3-3.5), no recent medical visits (OR 1.7, CI 1.0-2.9), and absence of chronic illness (OR 1.8, CI 1.1-2.8). Conclusions: This cohort of young addicted patients without primary care had very high health care utilization but many failed to link with primary medical care. Factors identified in this study suggest that linkage with primary medical care will require aggressive strategies that make use of episodic health care encounters and address perceptions of need for primary care.
Learning Objectives: At the conclusion of this session, learners will be able to: 1. Describe a cohort study of patients with addictions 2. Recognize factors associated with a failure to link with primary medical care 3. Generate hypotheses regarding barriers to primary medical care for persons with addictions
Keywords: Substance Abuse, Primary Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.