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Graduate internship presentation 05 2011

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Injection Drug Users’ Utilization of Health Care in New York City: …

Injection Drug Users’ Utilization of Health Care in New York City:
Abstract:
Through the principles of harm reduction, the Harm Reduction Coalition addresses the adverse affects of drug use. To better advocate for the health care needs of injection drug users, the student intern conducted a pilot study at syringe exchange programs. The pilot study included topical literature research, the formation of a community advisory board, a focus group, the administration of two surveys, and interviews with current and former injection drug users on their health care experiences. In addition, the student intern also videoed select interviewee’s anecdotes regarding health care for advocacy purposes. The student intern completed the design of the focus group moderator guide and interview protocol, design of the surveys, facilitation of the board, conduction of the focus group and interviews, video editing, and quantitative and qualitative research using the gathered data. The results will be compiled in a report to be used by the organization for advocacy purposes.

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  • 1. Harm Reduction Coalition Injection Drug Users’ Utilization of Health Care in New York City Melicia Laroco-Molter
  • 2. Harm Reduction Coalition Mission StatementThe Harm Reduction Coalition is a national advocacyand capacity-building organization that promotes thehealth and dignity of individuals and communitiesimpacted by drug use. HRC advances policies andprograms that help people address the adverse effectsof drug use including overdose, HIV, hepatitisC, addiction, and incarceration. We recognize that thestructures of social inequality impact the lives andoptions of affected communities differently, and workto uphold every individuals right to health and well-being, as well as in their competence to protectthemselves, their loved ones, and their communities.
  • 3. Principles of Harm Reduction Harm reduction is a set ofpractical strategies that reducenegative consequences of druguse, incorporating a spectrumof strategies from safer use, to managed use to abstinence. Harm reduction strategies meet drug users "where theyre at," addressing conditions of use along with the use itself.1. Clean Bottle 7. Cotton Balls2. Bleach 8. Syringes3. Bandages 9. Injection Instructions (Spanish &4. Sterile Water English)5. Tourniquet 10. Alcohol Swabs6. Bottle Cap/Cooker
  • 4. AbstractThrough the principles of harm reduction, the Harm ReductionCoalition addresses the adverse affects of drug use. To betteradvocate for the health care needs of injection drug users, thestudent intern conducted a pilot study at syringe exchangeprograms. The pilot study included topical literature research, theformation of a community advisory board, a focus group, theadministration of two surveys, and interviews with current andformer injection drug users on their health care experiences. Inaddition, the student intern also videoed select interviewee’sanecdotes regarding health care for advocacy purposes. Thestudent intern completed the design of the focus group moderatorguide and interview protocol, design of the surveys, facilitation ofthe board, conduction of the focus group and interviews, videoediting, and quantitative and qualitative research using thegathered data. The results will be compiled in a report to be usedby the organization for advocacy purposes.
  • 5. Introduction Learning Objective 1 Learning Objective 2Identify health care utilization and barriers Employ quantitative techniques to among IDUs at SEPs in New York City analyze surveys mentioned in LO1.Activity 1a: Develop survey(s) with Activity 1a: Performadvisory committee that will be descriptive analysis on dataadministered to the community.Activity 1b: Administer surveys to collected in LO1-1b.the community. Activity 2b: PerformActivity 1c: Interview stakeholders multivariate analysis toin the community regarding health examine relationshipcare utilization and barriers. between health care barriersActivity 1d: Conduct focus group(s)within the community. and health care utilizationActivity 1e: Pull main themes from among IDUs in New Yorkconducted interviews and focus City.groups.
  • 6. Health Problem and Justification• Injection drug use is • The NHBS conducted in associated with 36% of 2009 noted that 16% of HIV/AIDS cases in the NYC’s IDUs are infected US with HIV/AIDS• Among IDUs with • They also noted that HIV/AIDS, 50-90% are 51% of NYC IDUs used also infected with HCV speedballs and 70% of• In NYS, there are a NYC heroin IDUs quarter million injected daily IDUs, 35-50% with HIV/AIDSdrug use also increases the chances of overdose, Injection collapsed veins, soft skin and bacterial infections,endocarditis (heart infection), and septicaema (blood infection).
  • 7. Intern’s Roles The intern’s project was a preliminary, mixed methodsresearch project that focusedon the health care utilizationof injection drug users (IDUs) that patronize New York City’s syringe exchange programs (SEPs).The intern’s roles included:• A topical literature research• The formation and facilitation of a community advisory board• Moderating a focus group• Administration of two surveys• Conducting interviews with current and former IDUs on health care experiences• Coordination with NYC SEPs
  • 8. Research Methods• Topical literature • Survey development search• Site visits at • SEP administration participating SEPs of surveys – Stationery • Conduct interviews programs – Mobile Units • Video selected• Formation of advisory interviewees’ board retelling of health• Focus group care experiences
  • 9. Surveys
  • 10. Results Physical Health Survey• N=187 • 18.7% experienced barriers to• 24.1% female (N=45) 56.1% health care over a 12 month male (N=105) 2.7% period transgendered (N=5) • 15% of Spanish survey• 80.2% (N=150) in English respondents saw a health care 19.8% Spanish (N=37) professional compared to 50%• Age range of 25 and 64 (76% of English survey respondents or N= 142) • Spanish respondents fours• 75% indicated a diagnosis of times more likely to be HIV/AIDS or HCV unaware of places to go for services• Spanish respondents 1.6 times • Overall, respondents cited lack more like to de diagnosed with of transportation (1.8 times) & HCV or diabetes lack of insurance (1.556 times)• Twice as like to seek care at as a barrier health care the ER
  • 11. Results Mental Health Survey• N=24 • 20.8% (N=5) experienced• 29.2% female (N=7) barriers to receiving mental 54.2% male (N=13) health care• 95.8% (N=23) in English • Respondents cited provider 4.2% (N=1) in Spanish not speaking the person’s• Age range of 25 and 64 primary language (41.7%; (87.5% or N= 21) N=10), past poor treatment (16.7%; N=4), and the lack• 20.8% (N=5) received of transportation (16.7%; mental health care in the N=4) as barriers to receiving past 12 months mental health care• 41.7% (N=10) received care either while incarcerated or at a medical van
  • 12. Results Interviews Health & Health Care Stigma & Treatment• “Emergency rooms and being treated • “…I went to a hospital here…I always horribly and all kinds of stuff comes to had abdominal pain…they’d give me mind. But also just keeping yourself Maalox, send me home…this time my well, having a regular doctor. I think of abdominal pain was so bad I got off the positive aspects of health care in the table and I saw these scissors and my life and what I think what is I was trying to kill myself cause I supposed to happen is usually that you couldn’t take the pain. So when they have a primary care doctor and he can [the clinic personnel] saw that, they lead you around the rest of the phalanx decided to take me seriously and to you know get the resources you need…”(Mary, Caucasian, 30s) send me to [a hospital. When I walked in there, I had a gall bladder that was getting ready to erupt along• “Money…to get good health care you with seven gall stones – they told me gotta have a lot of money. You need an the size of golf balls. Now, I’ve been operation…you need a liver transplant going to the doctor all these or something like that, you know you years…nobody tried to figure out why gotta have Apple [a computer is she having all this abdominal pain. company+ kind of money…I’m so low on the scale. I have no income. I’m Because I was using drugs. And that basically homeless so that I can go into [the lack of appropriate health care] a hospital ad get relatively good health almost killed me… *She saw+ maybe care *via Medicaid+…”(Bob, African four or five *doctors+…” American, 40s) (Peggy, African American, 40s).
  • 13. Results Interviews Incarceration Disclosure• “some people think that • Many stated the importance of disclosing either their current or past because you went to jail or injection drug use. They cited the because you use drugs in complications of drug the past or whatever, that interactions, the need for appropriate pain medication, and the possibility they are so-called ‘better of their drug use as the cause of a than you’ but it’s not that health problem as reasons. way…” (Bill, Latino, 60s) • Those that did not disclose their drug use cited the fear of poor treatment Bill discovered that he has or the lack of necessity as reasons diabetes during a dental visit – Bob disclosed his drug use to his while in jail; the dentist found dentist in order to receive that he had loose teeth, a sign appropriate pain medication, but of gum damage due to did not disclose to his eye doctor. diabetes. Since then, he lost – Hamilton, a Caucasian man in his many of his teeth and sees a 30s, did not disclose his drug use to his allergist because he has doctor monthly to control his “known him since *he+ was 12 diabetes. years old and he was [his] doctor when *he+ was growing up.”
  • 14. Limitations• Pre-Survey Focus Group – Though useful, more time may have yielded richer data.• Communication – Though the intern attempted to reduce miscommunication among participating SEPs, additional project support & time could mitigate complications.• Language Barriers – There is a particular need for those with Spanish, Russian, Yiddish, and Chinese (Mandarin or Cantonese) language skills.• Cultural Barriers – This is particularly true in order to better serve the Chinese and Hasidic Jewish communities
  • 15. Recommendations for Future Research• The transgendered portion of the IDU community – Though the intern was unable to conduct interviews with self-identified transgendered persons, the intern noted the presence of the community at SEPs. – Injection drug use within the transgendered community is a growing concern, especially since the injected drugs may also be non-prescribed hormones and other items which SEPs may not have prior experience.

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