Addiction and Primary Care Access Sidney Shapiro, MA* and Priscilla Kandiah± * PhD Candidate, Rural and Northern Health, Laurentian University ± Biomedical Biology, Laurentian University Supervisor: Dr. Jacques Abourbih, NOSM

The Addiction and Primary Care Access Research Project Are addiction practices being used as an alternative to other forms of primary medical care in northern Ontario? Frequency of visits, co-morbidity factors, access to physicians, etc

The Addiction and Primary Care Access Research Project Future Research could compare sample to populations elsewhere in the north and in the south for a more comprehensive study.

The Addiction and Primary Care Access Research Project Project Phases Initial Design Aug 2013 Stakeholder Approvals Sep 2013 Ethics Nov 2013 Data Collection Ongoing, 2014 Analysis March 2014 Initial Results May 2014 We are here

The Addiction and Primary Care Access Research Project The project is based on the premise that certain populations in Northern Ontario have difficulties accessing primary health care physicians due to the shortage of family physicians (Rourke, 2003). This is particularly the case with patients in treatment for substance abuse, who often have a high rate of co-morbidity factors (Albion, 2010).

The Addiction and Primary Care Access Research Project The project is based on the premise that certain populations in Northern Ontario have difficulties accessing primary health care physicians due to the shortage of family physicians (Rourke, 2003). This is particularly the case with patients in treatment for substance abuse, who often have a high rate of co-morbidity factors (Albion, 2010). There is a scarcity of family health physicians in Northern Ontario (Pong, 2008). It has been observed that physicians with practices labelled as addiction focused, have also been assuming the role of family practice physicians and providing primary medical care. To what extent is this the case? As an alternative to a primary care physician in family practice, doctors who would normally only be engaged in addiction practice (eg. prescribing methadone or suboxone in treatment for opioid dependence), may prescribe various medications that are not related to addiction and are related to primary health care (Noel et. al, 2006).

The Addiction and Primary Care Access Research Project The Goal The study could lead to new understandings of primary care and addiction focused practice models, and help identify the challenges faced by addiction physicians. This includes the strain placed on them through acting as an readily available alternative source of primary health care. The study will determine the extent of this type of “diversion” and compare the trend across various populations through sub group analysis. The study will be purely quantitative, and form an initial impression of the data.

The Addiction and Primary Care Access Research Project Ethics Potentially vulnerable population Initial decision to do chart review Future studies can follow up using interviews or focus groups Anonymized patient information Coding and chart data extraction done at clinic with various safeguards, such as dual encryption and file storage (onsite at medical clinic) Permission obtained from stakeholders Custodian of records for medical charts with conditions to ensure security of records REB approval Expedited ethics process with revisions two rounds of modifications Nov, 2013 Will hold meetings with clinic To discuss findings and provide follow-up Potential gaps identified

The Addiction and Primary Care Access Research Project Data Population: n=300 Chart review Inclusion criteria: treatment in 2012 for any reason Variable include: age, sex, primary care physician status, pre-existing health conditions, average monthly dosage of methadone/suboxone, monthly prescriptions for addiction/non-addiction drugs and other (+/-300).

The Addiction and Primary Care Access Research Project Yes Family MD Yes Primary Script (non-addiction) No Primary Script No Family MD

The Addiction and Primary Care Access Research Project Methods Random ID key numbers assigned to patient files Internal Lime Survey installation run from a local WAMP host Quick data entry to MySQL database MySQL limitations Export data to SPSS for analysis Over 1,000,000 data fields to fill with information Examination of missing data (what does it mean?)

The Addiction and Primary Care Access Research Project Initial Analysis Demographics MMT Dosage (stability) Monthly Scripts Family MD status Health Status (?)

The Addiction and Primary Care Access Research Project Expected Results Resources Access to family physicians One site care options Stigma Socioeconomic reasons E.g. transportation options Number of non-addiction related scripts may indicate a lack of Is the data reflective of the larger population in treatment for addiction in northern / southern Ontario?

Thank you