Suboptimal non-medical qualities of primary care linked with care avoidance among people who use drugs in a Canadian setting amidst an integrated healthcare reform
Notice bibliographique
Résumé
Background: People who use unregulated drugs (PWUD) often face significant barriers to – and thereby avoid seeking – healthcare. In Vancouver, Canada, a neighborhood-wide healthcare system reform began implementation in 2016 to improve healthcare delivery and quality. In the wake of this reform, we sought to determine the prevalence of healthcare avoidance and its association with emergency department use among PWUD in this setting and examine patient-reported non-medical qualities of healthcare (“responsiveness”). Methods: Data were derived from two prospective cohort studies of community-recruited PWUD in Vancouver in 2017-18. Responsiveness was ascertained by the World Health Organizations’ standardized measurements and we evaluated seven domains of responsiveness (dignity, autonomy, communication, confidentiality, prompt attention, choice of provider, and quality of basic amenities). Pearson chi-squared test was used to examine differences in responsiveness between those who did and did not avoid care. Multivariable logistic regression was used to determine the relationship between care avoidance due to past mistreatment and emergency department use, adjusting for potential confounders. Results: Among 889 participants, 520 (58.5%) were male, 204 (22.9%) reported avoiding healthcare, most commonly for chronic pain (47.4%). Overall, 6.6% to 36.2% reported suboptimal levels (i.e., not always meeting the expected quality) across all seven measured domain of responsiveness. Proportions reporting suboptimal qualities were significantly higher among those who avoided care than those who did not across all domains, including: care as soon as wanted (51.0% vs. 31.8%), listened to carefully (44.1% vs. 20.4%), and involved in healthcare decision making (27.9% vs. 12.7%) (all p<0.05). In multivariable analyses, avoidance of healthcare was independently associated with self-reported emergency department use (adjusted odds ratio=1.49; 95% confidence interval:1.01–2.19). Conclusion: We found that almost a quarter of our sample of PWUD avoided seeking healthcare due to past mistreatment, and all seven measured domains of responsiveness were suboptimal and linked with avoidance. Individuals who reported avoidance of healthcare were significantly more likely to report emergency department use. Multi-level interventions are needed to remedy the suboptimal qualities of healthcare and thereby reduce care avoidance.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,005 |
| Études des sciences et des technologies | 0,007 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».