1. 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

2. 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

3. 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.

4. 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

5. 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).

6. 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).

7. 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.

8. 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

9. 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).

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

11. 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?)

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

13. 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?

14. Thank you