Unmet need for recommended preventive health services among clients of California syringe exchange programs: implications for quality improvement.
BACKGROUND
Comprehensive preventive services are recommended for injection drug users (IDU), including screening tests, vaccinations, risk reduction counseling, and sterile syringes. Syringe exchange programs (SEP) may facilitate receipt of preventive services by IDUs, but whether SEP clients receive recommended preventive care is not known. We examined use of recommended preventive services by clients of 23 SEPs throughout California.


METHODS
Five hundred and sixty SEP clients were recruited from 23 SEPs throughout California between March and September 2003. Receipt of 10 recommended preventive services and source of care (SEP versus non-SEP providers) was ascertained from client interviews.


RESULTS
On average, SEP clients received only 13% of recommended preventive services and 49% of clients received none of the recommended services. Of services that were received, 76% were received from SEPs. In multivariate analysis, use of drug treatment and more frequent SEP visits were associated with receipt of recommended preventive services by clients.


CONCLUSIONS
SEPs are often the only source of preventive care for their IDU clients. Still, SEP clients fail to receive most recommended preventive services. Interventions to increase use of preventive services and improve the quality of preventive care received by IDUs, such as increased access to drug treatment and SEPs, are needed.
Heinzerling
K G
KG
UCLA Robert Wood Johnson Clinical Scholars Program, 911 Broxton Avenue, Third Floor, Los Angeles, CA 90024, USA. heinzk@ucla.edu
Kral
A H
AH
Flynn
N M
NM
Anderson
R L
RL
Scott
A
A
Gilbert
M L
ML
Asch
S M
SM
Bluthenthal
R N
RN
D002140:California; D003376:Counseling; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control / Q000635:transmission; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D006801:Humans; D008403:Mass Screening; D016485:Needle Sharing / Q000009:adverse effects; D018671:Needle-Exchange Programs / Q000458:organization & administration*; D011314:Preventive Health Services / Q000458:organization & administration*; D011787:Quality of Health Care; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000150:complications*; D013594:Syringes