| Health care utilization is a important determinant of population health. Following recommendations from the WHO in 70s, many efforts have been deployed everywhere in the world to invite the population at preferentially using front line services instead of hospital emergency rooms and specialized services. For certain minorities and elderly in particular, hospital emergency rooms are still, most of the time, the main entry point to the health care system.;During the last decade, many studies have been carried out in Canada, more specifically in the Quebec, on the access to health care services for minority populations. Among them, injection drug users (IDUs) represent a category at risk for diverse diseases and their pattern of health service use is quite unexplored.;The purpose of this study is to describe the health care service utilization profile in Montreal IDUs and assess barriers to their primary health care service use, along with other factors that could explain their preferential utilization of hospital emergency services. Our attempts to address those two objectives have raised the requirement to cautiously describe IDIs' profile and, as a preliminary step, to explore factors associated with their high morbidity.;This work is a cross-sectional study. The targeted population is composed by IDUs in Montreal. Inclusion criteria are: having injected illicit drugs within the 6 months before interview, being 18 years old or over, and living in Montreal since 12 months or more before interview. The sampling was carried out from February to September 2005. The recruitment method consisted in contacting IDUs on the streets in Montreal city, informing them about the running of the study and its objectives, and distributing business cards with a telephone number they could call in case they were ready to take part in the study. The measurement instrument was a self-administered questionnaire. Overall 678 IDUs were interviewed. Among them 666 were included in the study for further analyses. Analyses were computed firstly on IDUs' living conditions in connection with their ill-health, secondly on factors associated with emergency room utilization versus primary health care use on the occurrence of an acute illness in the six months prior to the interview, and thirdly on factors associated with community health centers use versus medical cabinets among IDUs who reported visiting usually and exclusively primary health care settings for medical help.;IDUs health is mainly impacted by mental diseases [Odd ratio (OR): 2.09; 95% confidence interval (CI): 1.15-3.81], Human Immunodeficiency virus (HIV) infections (OR: 2.03; 95% CI: 1.00-4.14), and hepatitis C virus (HCV) infections (OR: 1.84; 95% CI: 1.07-3.15) that affect many of them. Other factors explaining morbidity among IDUs are risk behaviors (brand of drugs injected, sharing injection materials), marginality (homosexuality, bisexuality, begging, prostitution), financial strains, gender and age. Homeless IDUs (OR: 4.81; 95% CI: 1.18-19.60), as well as those who consume alcohol (OR: 2.79; 95% CI: 1.08-7.22) and non injection drugs (OR: 2.54; 95% CI: 0.95-6.80), are more likely to use emergency rooms. Among IDUs who usually visit primary health care services, the more deprived, such as the homeless prefer seeking medical help in community health centers (OR: 6.23; 95% CI: 1.53-25.32), whereas more integrated IDUs, particularly older IDUs (OR: 0.89; 95% CI: 0.82-0.97), are more prone to visit medical cabinets. Preventive and social services available in Montreal health system seem to target efficaciously populations at risk for diseases. A proportion of 74% participants had used any preventive health service in the past, and 49% subjects seek any material help in community centers.;To conclude, the high morbidity observed among IDUs seems to be mainly explained by their harsh living conditions. They use emergency services more frequently than the general population, due to numerous risk factors they face in their daily living. Exception to this overall view is that of more socially integrated IDUs who seem to use preferentially front line services, as does the general population. The findings of this study lead us to the recommendation of a more integrated social and health service in Quebec, and to more funding of social services in favor of IDUs.;Keywords. injection drug users, morbidity, harm reduction strategies, emergency department, primary health care, community health center, medical cabinet, utilization, Montreal, Canada. |
