title: Is a patient's type of substance dependence (alcohol, drug or both) associated with the quality of primary care they receive?
abstract: BACKGROUND
  Primary care clinicians' attitudes may differ based on patients' substance dependence type (alcohol, other drugs or both).
  
  
  OBJECTIVE
  The aim of this study was to evaluate whether substance dependence type is associated with primary care quality (PCQ).
  
  
  METHODS
  We tested the association between substance dependence type and six PCQ scales of the Primary Care Assessment Survey (PCAS) in multivariable linear regression models. We studied alcohol- and/or drug-dependent patients followed prospectively who reported having a PCC ( n = 427) in a primary care setting.
  
  
  RESULTS
  We used the Composite International Diagnostic Interview-Short Form to assess substance dependence type and we used the PCAS questionnaire to measure primary care quality. Dependence type was significantly associated with PCQ for all PCAS scales except whole-person knowledge. For the significant associations, subjects with drug dependence (alone or together with alcohol) had lower observed PCAS scores compared with those with alcohol dependence only, except for preventive counselling.
  
  
  CONCLUSIONS
  Drug dependence was associated with worse PCQ for most domains. Understanding the reasons for these differences and addressing them may help improve the quality of primary care for patients with addictions.
authors.affiliation: Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil. michaelabitarello@yahoo.com.br
authors.forename: Michaela Bitarello
authors.initials: MB
authors.lastname: do Amaral-Sabadini
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.forename: Christine
authors.initials: C
authors.lastname: Lloyd-Travaglini
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000175:diagnosis / Q000628:therapy; D001291:Attitude of Health Personnel; D003142:Communication; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000145:classification* / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*