Access to healthcare among managed alcohol program participants: A mixed methods study

Area of Science:

• Public Health
• Addiction Medicine
• Health Services Research

Background:

• Managed alcohol programs (MAPs) provide regulated alcohol doses to individuals with severe alcohol use disorders unresponsive to traditional treatments.
• These harm reduction initiatives aim to decrease alcohol-related harms and improve social determinants of health, including housing and healthcare access.
• Understanding the specific impact of MAPs on healthcare access is crucial for optimizing services for vulnerable populations.

Purpose of the Study:

• To evaluate the impact of participation in managed alcohol programs (MAPs) on healthcare access among individuals with high-risk drinking behaviors.
• To compare healthcare access between MAP participants and a matched control group.
• To explore qualitative experiences of MAP participants regarding healthcare utilization.

Main Methods:

• A mixed-methods design combining quantitative surveys and qualitative semi-structured interviews.
• Data collected from 188 MAP participants and 198 matched control participants across six Canadian cities (2014-2017).
• Longitudinal follow-up data analyzed for a subset of participants (n=82 MAP, n=116 control) to assess changes over time.

Main Results:

• Cross-sectional analysis showed MAP participants reported significantly higher regular (OR 1.77) and satisfactory (OR 2.02) healthcare access compared to controls.
• Longitudinal data indicated that when MAP participants were actively engaged in the program, they had increased likelihood of regular (OR 2.16) and satisfactory (OR 3.23) healthcare access.
• Qualitative themes revealed that MAPs facilitate healthcare access through integrated services, supportive environments, and relationship-building crucial for addressing complex needs.

Conclusions:

• Managed alcohol programs significantly enhance regular and satisfactory healthcare access for individuals with high-risk drinking behaviors, particularly those experiencing homelessness.
• The structured support and integrated services within MAPs are key facilitators of improved healthcare engagement.
• Long-term supportive care within MAPs is vital for improving health outcomes and healthcare utilization in this population.