Healthcare utilization among People Who Use Drugs (PWUDs): An examination from a study drug users in Methadone Maintenance Treatment

Background: DUs are at increased risk for HIV, HCV and other co-morbidities but have low rates of primary care utilization and high rates of emergency department (ED) utilization, which is indicative of poor access to medical care.

Methods Four hundred eighty-nine participants were recruited from drug treatment programs in NYC and SF to test the utility of a motivationally-enhanced care model for HCV. Baseline interviews assessed demographic characteristics, drug use and sexual risk behaviors, and health care use in the past 3 months.

Results Fifty-nine percent were HCV+, 10% HIV+ and 70% had ever injected drugs. In the 3 months prior, 15% spent >=1 night in the hospital (mean=1.4 visits), 27% used the emergency department (ED) (mean=1.6 visits), 48% had a primary care visit (mean=3.5 visits). Hospital stays and ED visits were most commonly for bacterial infections, (18% and 15% respectively); and one-third of the primary care visits were for routine medical exams. HCV+ and HIV+ DUs were more likely to have seen a doctor (p=.004 and p=.004, respectively) and participants who had seen a doctor were less likely to utilize the ED (p=<.0001). Participants with a history of injection drug use (IDU) were less likely to have seen a doctor (p=.006).

Conclusions Preliminary findings indicate that approximately half of the participants obtained routine medical care in the previous three months, with HCV+ and HIV+ participants significantly more likely. Participants who had visited a doctor were less likely to have used ED services and IDUs were less likely to have seen a doctor.