Profiles of quality of outpatient care use, associated sociodemographic and clinical characteristics, and adverse outcomes among patients with substance-related disorders

Fleury, Marie-Josée; Cao, Zhirong; Grenier, Guy; Huỳnh, Christophe

doi:10.1186/s13011-022-00511-0

Substance Abuse Treatment, Prevention, and Policy

Table 1 Characteristics of patients using addiction treatment services (N = 18,215, or other as specified)

From: Profiles of quality of outpatient care use, associated sociodemographic and clinical characteristics, and adverse outcomes among patients with substance-related disorders

	n	%
Outpatient service use characteristics (measured in 2014–15 (April 1–March 31), or other as specified)
Usual outpatient physician ^a
Usual general practitioner (GP) only	6503	35.70
Usual psychiatrist only	1278	7.02
Both GP and psychiatrist	1847	10.14
No usual physician	8587	47.14
Frequency of consultations with usual GP ^a
0–1	9865	54.16
2–3	4243	23.29
4+	4107	22.55
Frequency of consultations with usual psychiatrist ^a
0	15,090	82.84
1–3	1375	7.55
4+	1750	9.61
High continuity of physician care from usual GP or psychiatrist (≥0.8) ^b	7945	43.62
Frequency of psychosocial interventions received in community healthcare centers (excluding GP consultations) ^c
0	10,905	59.87
1–3	3744	20.55
4+	3566	19.58
Frequency of interventions provided in any treatment programs attended for SRD in addiction treatment centers ^d
0	12,564	68.98
1–3	1756	9.64
4+	3895	21.38
Percentage of patient dropouts from any SRD program in addiction treatment centers (measured from 2009 to 10 to 2014–15) ^e
Low (0 to 33%)	6511	35.74
Moderate (34 to 66%)	3856	21.17
High (67 to 100%)	7848	43.09
Regularity of outpatient care with any provider (3 months per period) ^f
Low (services received in 1 or 2 periods, or less than 2 services received)	9449	51.87
Moderate (services received in 3 periods)	3373	18.52
High (services received in 4 periods)	5393	29.61
Patient sociodemographic characteristics (measured in 2014–15 or the last year available, or other as specified)
Men	11,929	65.49
Age group (years)
12–24	3790	20.81
25–44	8183	44.92
45–59	4889	26.84
60+	1353	7.43
Living alone or single parent (n = 16,381)	7518	45.89
Occupation
Work or study	8096	44.44
Unemployed	9923	54.48
Retired	196	1.08
Living in more materially deprived areas: Indexes 4–5 or areas not assigned ^g	10,205	56.03
Living in more socially deprived areas: Indexes 4–5 or areas not assigned ^g	11,278	61.92
Type of residential areas ( = 18,197)
Urban areas (> 100,000)	9417	51.75
Semi-urban areas (10,000 to 100,000)	5323	29.25
Rural areas (< 10,000)	3457	19.00
Criminal history with or without incarceration (measured from 2009 to 10 to 2014–15)	3476	19.08
History of homelessness (measured from 2009 to 10 to 2014–15)	2446	13.43
Patient clinical characteristics (measured from 2012 to 13 to 2014–15, or other as specified)
Type of substance-related disorders (SRD)
Drugs only	5440	29.86
Alcohol only	3768	20.69
Polysubstances	9007	49.45
Number of years with SRD (measured from 1996 to 97 to 2014–15)
1–2	8244	45.26
3–5	5611	30.80
6+	4360	23.94
Principal mental disorders (MD) ^h
Serious MD	3930	21.58
Personality disorders	1971	10.82
Common MD	6682	36.68
No MD	5632	30.92
Chronic physical illnesses ⁱ	6771	37.17
Patient adverse outcomes (measured in 2015–16)
Frequent emergency department (ED) use (3+/year) for any medical reason ^j	3272	17.96
Hospitalizations for any medical reason	3095	16.99
Death from any medical cause	164	0.90

^aUsual outpatient physician includes general practitioner (GP) and psychiatrist. Usual GP is a proxy for “patient family physician”, as this information is not available in administrative databases. Usual GP is one with whom the patient had at least two consultations or at least two consultations with GP working in the same family medicine group, as defined in the Methods section. Usual psychiatrist is defined as one that followed the patient in outpatient care at least twice. Alternatively, patients who made only one outpatient consultation with a psychiatrist had to have consulted their GP at least twice, which was considered a proxy for collaborative care (see references in Methods section)
^bContinuity of physician care is measured with the Usual Provider Continuity Index, describing the proportion of consultations with the usual GP or psychiatrist of all GP and psychiatrists consulted in outpatient care, including consultations in walk-in clinics. A score ≥ 0.80 is considered high continuity of care. References are provided in Methods section
^cCommunity healthcare centers provide mainly psychosocial interventions delivered through multidisciplinary teams (e.g., social workers, nurses, psychologists). These services are thus complementary to the care provided by GP, and both are primary care (or first line) services
^dTreatment programs offered in addiction treatment centers included: medical activities (e.g., opioid agonist treatment), specialized addiction services, either internal (e.g., detoxification treatment) or external (e.g., counseling, rehabilitation), and brief treatment (see Methods section)
^eThe addiction treatment center database (SIC-SRD) provided reasons justifying patient case closure (e.g., treatment dropout, treatment completion, patient relocation to another area not covered by the center). It was possible to calculate the percentage of dropouts per patient, accounting for all programs used by the patient over the 6-year data collection period
^fOutpatient care integrates care from GP, psychiatrists, and clinicians from community healthcare centers and addiction treatment centers. This variable measured how care, whether regulatory or not, was provided during the 12-month period. Patients could receive high regularity of care (interventions received one or several times every 4 months within the 12-month period), moderate regularity of care (interventions received for 3 periods of 3 months in the 12-month period) or low regularity of care (all other possibilities)
^gMaterial and social deprivation indexes are related to the smallest residential dissemination areas (zip code areas), based on the 2011 Canadian census. For this study, quintiles were regrouped into two levels representing the less (1–3) and more (4–5 or not assigned) deprived areas. “Not assigned” areas related to missing address or living in an area where index assignment was not feasible. An index cannot usually be assigned to residents of nursing homes or to homeless individuals. The “not assigned areas” were integrated with indexes 4–5 as the more socially deprived areas, as they usually related also to deprived populations
^hPrincipal MD include inclusive and hierarchical groups representing the most serious MD. For example, if a patient had both bipolar disorders and personality disorders, then he/she was classified with bipolar disorders, and integrated within serious MD
ⁱChronic physical illnesses included: renal failure, cerebrovascular illnesses, neurological illnesses, endocrine illnesses, tumor without or with metastasis, chronic pulmonary illnesses, diabetes complicated and uncomplicated, cardiovascular illnesses, and other chronic illness categories (e.g., blood loss anemia) (see Appendix 1)
^jA minimum of three visits per year is the standard definition for frequent ED use, based on previous research. References are provided in the methods section

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