title: High rates of primary care and emergency department use among injection drug users in Vancouver.
abstract: BACKGROUND
  Frequent use of emergency rooms by injection drug users (IDUs) has been attributed to a lack of access to primary care and barriers to health services. Using a community-based sample of IDUs, we examined rates of primary care and emergency room use among IDUs and identified correlates of frequent emergency department use.
  
  
  METHODS
  From January to November 2003, we enrolled IDUs into a prospective cohort study involving a baseline questionnaire, comprehensive retrospective and prospective health record linkages. We examined rates of primary care and emergency department utilization, and diagnoses upon arrival in the emergency room. Logistic regression was used to determine factors independently associated with frequent emergency room use.
  
  
  RESULTS
  Of the 883 IDUs included in this analysis, 687 (78 per cent) accessed a primary care clinic in the previous year, while 528 (60 per cent) participants accessed the emergency room (ER) during the years 2002 and 2003. Abscesses, cellulitis and other skin infections accounted for the greatest proportion of ER use. Factors independently associated with frequent ER use included: frequent crystal methamphetamine injection (AOR = 2.4, 95 per cent CI: 1.0-5.6); non-fatal overdose (AOR = 2.1, 95 per cent CI: 1.4-3.3); HIV-positive status (AOR = 1.5, 95 per cent CI: 1.1-2.1), having been physically assaulted (AOR = 1.5, 95 per cent CI: 1.1-2.1); and primary care utilization (AOR = 1.5, 95 per cent CI: 1.0-2.1).
  
  
  CONCLUSIONS
  high rates of ER use were observed among IDUs, despite high rates of primary care use among this same population. ER use was due primarily to preventable injection-related complications that are less amenable to primary care interventions, and therefore educational and prevention efforts that encourage and enable sterile injection practices should be promoted.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Canada. tkerr@aidslaw.ca
authors.forename: T
authors.initials: T
authors.lastname: Kerr
authors.forename: E
authors.initials: E
authors.lastname: Wood
authors.forename: E
authors.initials: E
authors.lastname: Grafstein
authors.forename: T
authors.initials: T
authors.lastname: Ishida
authors.forename: K
authors.initials: K
authors.lastname: Shannon
authors.forename: C
authors.initials: C
authors.lastname: Lai
authors.forename: J
authors.initials: J
authors.lastname: Montaner
authors.forename: M W
authors.initials: MW
authors.lastname: Tyndall
mesh_terms: D000328:Adult; D017677:Age Distribution; D001955:British Columbia / Q000453:epidemiology; D062787:Drug Overdose; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000453:epidemiology / Q000209:etiology; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008694:Methamphetamine / Q000008:administration & dosage; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D011446:Prospective Studies; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology*; D011795:Surveys and Questionnaires
chemical_list: D008694:Methamphetamine