Coast to Coast Seminar Series: "Primary Health Care Utilization for Alcohol-Attributed Diseases in British Columbia"

Abstract

In the past 5 years there has been a renewed focus on the importance of primary health care to reducing health inequities through regular screening and health promotion counselling that work to detect illnesses early in their development and address negative health behaviours among patient populations. The importance of primary health care to the identification of persons at risk of developing mental and physical health conditions is highly apparent in relation to alcohol consumption, which is a significant contributor to premature mortality in Canada. Previous research on health care use and alcohol consumption in BC has focused on secondary and tertiary level services that are accessed by only a small proportion of all at-risk drinkers in the province. The purpose of this project was to address this significant knowledge gap by measuring variations in general practitioner visits for alcohol-attributed diseases using physician-billing data from 2001-2011.

Data sources:

Medical Services Plan Collection (BC Ministry of Health) 2001-2011 Registry Collection 2001-2011 Registry Demographics Collection 2001-2011 Data analysis:

Data were modeled using negative binomial regression to measure trends in the cases and visits to general practitioners for alcohol-attributed diseases, and identify regional variations in consultations over the ten-year period.

Policy implications:

This project was developed to address the lack of information on primary health care utilization by persons with substance use issues in BC - and Canada more generally - given the recent focus on leveraging opportunities in family physician practices to encourage greater use of screening tools and brief interventions. This is the first known project to examine alcohol-attributed diseases in BC – and Canada - using multi-year administrative primary health care data. One of the central policy implications of this project is that there is far greater utilization of general practitioners services for alcohol-attributed diseases than hospitals, and that consultations in primary health care practices have been significantly increasing since 2001. These findings support the further use of primary health care data for understanding the incidence of substance use-related diseases in BC.

Key findings:

Since 2001 there have been significant increases in the number of persons presenting to general practitioners with alcohol-attributed diseases in all Health Authorities. General practitioner visits for alcohol-attributed diseases significantly increased by 53.3% from 14,882 cases in 2001 to 22,823 cases in 2011 (p<.001). Most visits to general practitioners for alcohol-attributed diseases were for alcohol dependency syndrome (86%). While the number of AAD cases increased from 2001-2011, the frequency of visits to general practitioners significantly decreased from 3.9 in 2001 to 2.7 visits per case in 2011 (F=428.1, p<.001) Most (65%) general practitioner consultations took place in a family doctor’s office in the community; however there were some marked variations in the service locations of general practitioner visits based on disease type and region. Most rural and northern areas of BC had above average rates of general practitioner consults for alcohol-attributed diseases, and a much higher proportion of these visits took place in emergency rooms and hospital settings. From January 1, 2001 to December 31, 2011 some of the largest increases in alcohol-related disease cases were in rural or remote Health Service Delivery Areas (HSDAs). In the Northwest HSDA cases rose 77.2% from 57.1 per 10,000 in 2001 to 101.3 per 10,000 in 2011. The 2011 rate of AAD cases per 10,000 in the Northwest HSDA was the highest in the province - almost double the provincial HSDA average of 48.2 AAD cases per 10,000.