Background
Methods
Study setting
Procedure
Variables
Statistical analyses
Results
Low service users | Moderate service users | High service users | |
---|---|---|---|
n = 1,175 |
n = 3,007 |
n = 225 | |
Description of service users according to their number of consultations with general practitioners and psychiatrists | 25th percentile or lower | 26–95th percentile | 95th percentile or higher |
Total number of consultations with general practitioners and psychiatrists | 6,516 | 108,523 | 41,334 |
Range of consultations with general practitioners and psychiatrists | 1–10 | 11–113 | 114–639 |
Proportion of consultations with general practitioners and psychiatrists | 4.2 % | 69.4 % | 26.4 % |
Average number of consultations with general practitioners and psychiatrists (2-year period)
| 5.5 ± 2.9 | 36.1 ± 23.3 | 183.7 ± 80.2 |
Average number of consultations with general practitioners and psychiatrists (per month)
| 0.2 ± 0.1 | 1.5 ± 1.0 | 7.7 ± 3.3 |
Average number of hospitalizations (2-year period)
| 1.3 ± 0.7 | 1.9 ± 1.4 | 4.5 ± 3.5 |
Average number of emergency department contacts (2-year period)
| 1.0 ± 0.3 | 1.6 ± 1.2 | 3.8 ± 2.8 |
Variable | Low service usersa
| Moderate service usersb
| High service usersc
| Low service users vs. High service users | Moderate service users vs. High service users |
---|---|---|---|---|---|
N = 1,175 |
N = 3,007 |
N = 225 | pd
| pe
| |
Predisposing factors | |||||
Sex | 0.065 | 0.119 | |||
Female | 360 (30.6 %) | 1 269 (42.2 %) | 83 (36.9 %) | ||
Male | 815 (69.4 %) | 1 738 (57.8 %) | 142 (63.1 %) | ||
Age group | 0.002 | 0.424 | |||
up to 30 years | 353 (30.0 %) | 621 (20.7 %) | 51 (22.7 %) | ||
30 to 49 years | 613 (52.2 %) | 1 702 (56.6 %) | 119 (52.9 %) | ||
50-64 years | 187 (15.9 %) | 578 (19.2 %) | 43 (19.1 %) | ||
65 years and above | 22 (1.9 %) | 106 (3.5 %) | 12 (5.3 %) | ||
Enabling factors | |||||
Neighborhood characteristics
| |||||
Population density (per km2) | 7,218.6 ± 3,013.8 | 7,048.3 ± 2,877.3 | 6,494.9 ± 2,957.0 | 0.007 | 0.024 |
1st quintile of neighborhood material deprivation | 23.07 ± 21.56 | 21.02 ± 20.63 | 22.02 ± 20.11 | 0.582 | 0.567 |
5th quintile of neighborhood material deprivation | 23.54 ± 20.78 | 23.91 ± 20.30 | 23.54 ± 20.78 | 0.400 | 0.833 |
1st quintile of neighborhood social deprivation | 5.63 ± 9.09 | 5.12 ± 8.08 | 6.12 ± 8.96 | 0.547 | 0.147 |
5th quintile of neighborhood social deprivation | 50.60 ± 23.39 | 51.63 ± 23.35 | 50.40 ± 24.40 | 0.924 | 0.537 |
% of men | 48.44 ± 1.69 | 48.40 ± 1.74 | 48.33 ± 1.65 | 0.462 | 0.650 |
% of persons aged up to 30 | 37.28 ± 2.76 | 37.16 ± 2.68 | 36.94 ± 2.65 | 0.163 | 0.347 |
% of persons aged 30-49 | 16.33 ± 2.69 | 16.21 ± 2.59 | 15.86 ± 2.42 | 0.048 | 0.117 |
% of persons aged 50-64 | 16.96 ± 1.61 | 17.06 ± 1.50 | 17.33 ± 1.50 | 0.010 | 0.033 |
% of persons 65 years and over | 14.14 ± 3.33 | 14.26 ± 3.35 | 14.55 ± 3.20 | 0.158 | 0.305 |
% of recent immigrants | 7.27 ± 3.41 | 7.02 ± 2.93 | 6.84 ± 2.88 | 0.149 | 0.472 |
Level of neighborhood social fragmentation | 6.11 ± 4.43 | 6.07 ± 4.32 | 5.69 ± 4.28 | 0.282 | 0.295 |
Distance to the ARC (in km) | 1.60 ± 0.87 | 1.65 ± 0.84 | 1.57 ± 0.93 | 0.624 | 0.212 |
Number of alcohol outlets with video lottery terminal | 18.80 ± 8.13 | 18.80 ± 7.97 | 19.08 ± 8.21 | 0.699 | 0.675 |
Number of alcohol outlets without video lottery terminal | 175.1 ± 83.41 | 171.4 ± 77.72 | 167.26 ± 83.02 | 0.295 | 0.528 |
Health services utilization
| |||||
Consulted other medical professionals | 838 (71.3 %) | 2 721 (90.5 %) | 221 (98.2 %) | <.001 | <.001 |
Number of programs used in the ARC | <.001 | 0.002 | |||
1 | 1 064 (90.6 %) | 2 449 (81.4 %) | 170 (75.6 %) | ||
2 to 3 | 110 (9.4 %) | 531 (17.7 %) | 48 (21.3 %) | ||
4 to 5 | 1 (0.0 %) | 27 (0.9 %) | 7 (3.1 %) | ||
Duration of care episode at the ARC | 0.074 | 0.125 | |||
Less than one year | 691 (60.9 %) | 1 575 (55.7 %) | 124 (58.5 %) | ||
One year | 253 (22.3 %) | 652 (23.0 %) | 44 (20.8 %) | ||
Two years | 93 (8.2 %) | 305 (10.8 %) | 19 (9.0 %) | ||
Three years | 42 (3.7 %) | 133 (4.7 %) | 17 (8.0 %) | ||
Four years and more | 55 (4.9 %) | 165 (5.8 %) | 8 (3.8 %) | ||
Duration in the program in the ARC (in years) | 0.310 | 0.214 | |||
Less than one year | 825 (70.2 %) | 2 013 (66.9 %) | 161 (71.6 %) | ||
One year | 209 (17.8 %) | 573 (19.1 %) | 40 (17.8 %) | ||
Two years | 70 (6.0 %) | 199 (6.6 %) | 14 (6.2 %) | ||
Three years | 24 (2.0 %) | 87 (2.9 %) | 7 (3.1 %) | ||
Four years and more | 47 (4.0 %) | 135 (4.5 %) | 3 (1.3 %) | ||
Need factors | |||||
Diagnoses of substance abuse | 221 (18.8 %) | 1 528 (50.8 %) | 190 (84.4 %) | <.001 | <.001 |
Alcohol abuse | 70 (6.0 %) | 1 216 (40.4 %) | 149 (66.2 %) | <.001 | <.001 |
Drug abuse | 156 (13.3 %) | 868 (28.9 %) | 171 (76.0 %) | <.001 | <.001 |
Concomitant drug and alcohol abuse | 17 (1.5 %) | 493 (16.4 %) | 122 (54.2 %) | <.001 | <.001 |
Schizophrenia | 8 (0.7 %) | 334 (11.1 %) | 113 (50.2 %) | <.001 | <.001 |
Mood disorder | 42 (3.6 %) | 792 (26.3 %) | 146 (64.9 %) | <.001 | <.001 |
Anxiety disorder | 199 (16.9 %) | 1 965 (65.4 %) | 212 (94.2 %) | <.001 | <.001 |
Personality disorder | 16 (1.4 %) | 481 (16.0 %) | 117 (52.0 %) | <.001 | <.001 |
Number of mental disorders | <.001 | <.001 | |||
0 | 954 (81.2 %) | 842 (28.0 %) | 4 (1.8 %) | ||
1 | 179 (15.2 %) | 1 123 (37.4 %) | 33 (14.7 %) | ||
2 | 40 (3.4 %) | 737 (24.5 %) | 60 (26.7 %) | ||
3 | 2 (0.2 %) | 245 (8.2 %) | 77 (34.2 %) | ||
4 | 0 (0.0 %) | 60 (2.0 %) | 51 (22.7 %) | ||
Number of physical comorbidity | <.001 | <.001 | |||
0 | 895 (76.2 %) | 1 433 (47.7 %) | 56 (24.9 %) | ||
1 to 2 | 262 (22.3 %) | 1 266 (42.1 %) | 107 (47.6 %) | ||
3 to 5 | 18 (1.5 %) | 283 (9.4 %) | 49 (21.8 %) | ||
6 and over | 0 (0.0 %) | 25 (0.8 %) | 13 (5.8 %) | ||
Concomitant substance and mental disorders | 58 (4.9 %) | 1 191 (39.6 %) | 186 (82.7 %) | <.001 | <.001 |
Concomitant substance and physical disorders | 51 (4.3 %) | 844 (28.1 %) | 144 (64.0 %) | <.001 | <.001 |
Concomitant mental and physical disorders | 56 (4.8 %) | 1 158 (38.5 %) | 167 (74.2 %) | <.001 | <.001 |
Concomitant substance, mental and physical disorders | 11 (0.9 %) | 660 (21.9 %) | 142 (63.1 %) | <.001 | <.001 |
OR | SE | 95 % CI | pa
| ||
---|---|---|---|---|---|
Lower | Upper | ||||
Predisposing factors | |||||
Sex (ref = female) | 0.99 | 0.24 | 0.62 | 1.59 | .975 |
Age group (ref = 29 years old and younger) | |||||
30–49 years | 1.05 | 0.33 | 0.55 | 1.99 | .893 |
50–64 years | 0.80 | 0.42 | 0.35 | 1.84 | .601 |
65 years and older | 4.14 | 0.69 | 1.06 | 16.08 | .040 |
Enabling factors | |||||
Neighborhood characteristics
| |||||
Population density (per square Km) | 1.00 | 0.00 | 1.00 | 1.00 | .130 |
1st quintile of neighborhood material deprivation | 0.99 | 0.03 | 0.92 | 1.05 | .654 |
5th quintile of neighborhood material deprivation | 1.01 | 0.01 | 0.99 | 1.03 | .436 |
1st quintile of neighbourhood social deprivation | 1.11 | 0.09 | 0.93 | 1.33 | .255 |
5th quintile of neighbourhood social deprivation | 1.04 | 0.03 | 0.98 | 1.10 | .160 |
% of men | 0.79 | 0.26 | 0.47 | 1.32 | .375 |
% of persons aged up to 30 | 2.09 | 0.46 | 0.85 | 5.16 | .110 |
% of persons aged 30–49 | 3.05 | 0.44 | 1.28 | 7.29 | .012 |
% of persons aged 50–64 | 3.89 | 0.56 | 1.31 | 11.56 | .015 |
% of persons 65 years and over | 1.60 | 0.38 | 0.75 | 3.40 | .220 |
% of recent immigrants | 1.03 | 0.21 | 0.68 | 1.54 | .893 |
Level of neighbourhood social fragmentation | 0.90 | 0.22 | 0.59 | 1.37 | .613 |
Distance to the ARC (in km) | 0.61 | 0.29 | 0.34 | 1.08 | .090 |
Number of alcohol outlets with video lottery terminal | 1.03 | 0.02 | 0.99 | 1.08 | .101 |
Number of alcohol outlets without video lottery terminal | 1.00 | 0.01 | 0.99 | 1.01 | .984 |
Health services utilization
| |||||
Consulted other medical professionals | 3.97 | 0.70 | 1.00 | 15.69 | .050 |
Number of programs used (ref = one program) | |||||
2 to 3 programs | 0.64 | 0.27 | 0.38 | 1.07 | .089 |
4 to 5 programs | 0.37 | 0.75 | 0.08 | 1.60 | .182 |
Duration of care episode at the ARC (ref = less than a year) | |||||
One year | 1.65 | 0.29 | 0.93 | 2.95 | .088 |
Two years | 1.00 | 0.37 | 0.49 | 2.06 | .994 |
Three years | 4.48 | 0.42 | 1.95 | 10.29 | <.001 |
Four years or more | 0.52 | 0.98 | 0.08 | 3.55 | .504 |
Duration in the program in the ARC (ref = less than a year) | |||||
One year | 0.51 | 0.40 | 0.23 | 1.10 | .087 |
Two years | 0.89 | 0.44 | 0.37 | 2.12 | .786 |
Three years | 0.31 | 0.74 | 0.07 | 1.32 | .114 |
Four years or more | 0.63 | 1.05 | 0.08 | 4.90 | .656 |
Need factors | |||||
Diagnosis of substance abuse | 0.95 | 0.94 | 0.15 | 6.03 | .961 |
Alcohol abuse | 2.41 | 0.72 | 0.59 | 9.85 | .220 |
Drug abuse | 3.41 | 0.64 | 0.98 | 11.87 | .054 |
Concomitant drug and alcohol abuse | 1.65 | 0.65 | 0.46 | 5.89 | .443 |
Schizophrenia | 4.74 | 0.21 | 3.14 | 7.16 | <.001 |
Mood disorder | 2.65 | 0.19 | 1.83 | 3.82 | <.001 |
Anxiety disorder | 2.34 | 0.30 | 1.29 | 4.25 | .005 |
Personality disorder | 3.42 | 0.26 | 2.07 | 5.65 | <.001 |
Number of physical comorbidities (ref = no comorbidity) | |||||
1 to 2 | 0.41 | 0.97 | 0.06 | 2.77 | .363 |
3 to 5 | 0.67 | 1.00 | 0.09 | 4.78 | .689 |
6 and over | 9.86 | 0.95 | 1.53 | 63.70 | .016 |
Concomitant substance abuse and mental disorders | 0.48 | 0.55 | 0.16 | 1.39 | .175 |
Concomitant substance abuse and physical disorders | 1.40 | 0.72 | 0.34 | 5.76 | .642 |
Concomitant mental and physical disorders | 4.43 | 0.92 | 0.73 | 26.78 | .105 |