The Geography of Alcohol-Related Harm Primary Healthcare Utilization in
Bc, Canada

Overview
– Project Purpose + Conceptual Framework
– Geography
– Manuscripts 1-3
– Rationale Research Methods Contribution
– Project Outcomes
– Conclusion
– Questions?

Problem Statement
Alcohol-attributed illnesses (AADs) are significant contributors to morbidity and premature mortality in Bc (BC)
This Year, 23.4% of deaths in BC (BCVSA, 2011)

Insufficient Research on:
Rates of AADs and potential need/demand
Current utilization of healthcare services for AADs
Impact of geography on AAD development and treatment

Project Purpose
Improve our knowledge of the geographies of alcohol-related harm, and connected utilization of primary health services for alcohol-attributed illnesses throughout BC.

Harm -Disease Development – Healthcare Utilization

Dissertation Components:
1. Community Index of Alcohol-Related Harm in BC
2. Primary Care Utilization for AADs
3. Experience with Primary Care Doctors
Conceptualizing Health Services Use
– Andersen/Newman’s Behavior Type of Health Services Use

3 Groups of things influence healthcare utilization:
1) Atmosphere 2) Population characteristics 3) Health behaviors

* Variables from each category are incorporated in a number of aspects of the suggested project

What’s Geography got related to it?
Space + Place
– AADs and treatment vary across spaces (urban v. rural)
Place influences AADs and treatment (primary v. secondary care)

Units of research
– Two three units of research are spatial. (HSDAs + LHAs)

Geography Matters
– Geography of injury, disease and treatment are essential to planning health services (Need-based planning exercises)

– Helps identify disparities between populations and regions
– Collate data into understandable/accessible formats

Manuscript 1
Community Index of Alcohol-Related Harm in BC
Objective
Develop a social indicator index of alcohol-related harm for Bc
Rationale

* Compile data for need- based planning
* Identify regional variations in alcohol-related harm in BC

– Social indicator approach
-Quantitative
-Indirect measurement of treatment need

Research Methods
-Used formerly in america for need-based planning/resource allocation

-Strong good reputation for geographers developing social indicator indexes

Scale and Measures
– Local Health Area scale (N=89)
– Study Measures: Alcohol-attributed deaths Average Age Liquor Outlet Density Per Person Consumption data

Data Analysis
-Ranking of LHAs by indicator using z-scores for every indicator
-Z-scores put into compile overall index to recognize at-risk regions when compared with others
-SPSS/ArcGIS

Variance + Observation Structures
Principal Component Analysis – SPSS 18
Compress all variables by LHA
See whether the variables are + or – influencing each other
Set of the share from the variance related to each variable

Contribution
Measure regional variations in alcohol-related harm across BC
Identify LHAs that may need preventative/harm reduction programming
Need-based planning resource

* Data underestimates liquor
consumption/use
* Errors in coding deaths

* Doesn’t directly measure demand, need or adequacy of current treatment services.
Primary Care Use for Alcohol-
Attributed Illnesses
Rationale
-Limited knowledge of primary care use for AADs in BC
– Essential for calculating potential need/interest in services
Why Gps navigation?
+ Most accessible doctor
+ Most reliable doctor
+ Leverage possibilities for elevated access
Measure rates of primary healthcare utilization across BC for alcohol-attributed illnesses across time (2001-2011) and space (HSDAs).
Manuscript 2: Objective
Research Methods
– Quantitative
– Medical Services Plan (MSP)
billing data from PopDataBC
– Data for 7 wholly alcohol-
attributed illnesses (ICD-9)

1. Descriptive statistics for those years by AAD
(Provincial level)

2. Poisson Regression: Quantity of visits by
AAD per 100,000 persons by year
(Provincial level) (2001 through 2011)

3. Poisson Regression/ArcGIS: Quantity of
visits by AAD per 10,000 persons by HSDA
(2001 + 2011)

+ Offset variable transforms count data into rates (to standardize by population)
– Commonly used in health research to accomplish time-series analysis

Why Poisson Regression?
Overall Project Outcomes
Understanding Distribution:
+ 3 Manuscripts

Understanding Exchange:
+ Web-based Tools/Social Networking

Practicality + Ethical Factors
-UVic REB Approval Needed (Waiver for Manuscripts 1+2 Full review for Manuscript 3)
-PopDataBC Data Access Request (DAR) Needed

Conclusion
-Novel Data: Administrative + Qualitative
-Geographical (Space + place) orientation
-Applied health research
-Implications for drinking + treatment policy/programs

Thank y u.
Amanda Slaunwhite Department of Geography
Manuscript 2: Contribution
Measure rates of primary care utilization on the 120 month period (2001-2011)
Potentially determine the outcome of liquor store privatization on presentation of AADs in primary care practices
Improved knowledge of the level of patients seeking strategy to AADs across some time and geography

Limitations
Data incorrectly coded by ICD-9 code
Data excludes from province visits by persons with BC Medical Health Insurance (Communities close to the Alberta border) and salaried Gps navigation

Manuscript 3
Treating Alcohol-Attributed Illnesses in Rural and Remote BC
Rationale
Drinking in rural and remote areas continues to be typically considered a substantial ailment
Elevated rates of consumption/morbidity/mortality

Gps navigation have been in a distinctive role to advertise low-risk consumption/treat AADs (Insufficient secondary/tertiary services)
Much promise briefly interventions/screening tools:
Economical (Reduce disease severity inexpensive of delivery)
High effectiveness (Reduce consumption improve health outcomes)

Concentrate on Family Doctors in Rural/Remote Areas
Research Methods
Mixed method research design
Quantitative (Questionnaire) and Qualitative (Interview) data
Phenomenological approach:
Exploratory/descriptive research – experiential understanding.

Sampling
Purposeful sample of

40 Gps navigation 60 Km from major regional hospitals
Identified from postal codes within the BC Physician Directory
Contacted via telephone and asked to sign up
Measures
1. Questionnaire

2. Semi-Structured
Interviews
Questionnaire: Web (Fluid Surveys) or paper-based
Practice information
Kinds of alcohol-related harms
Existing services locally
Referral systems
Complete missing questionnaire information
Develop questionnaire responses:
Experience dealing with other health/social providers
Concerns with specific alcohol-related harms
Semi-Structured Interviews: Telephone
Identify any supports/services that will help Gps navigation support persons with AADs in rural and remote places
Data Analysis
1. Questionnaire: SPSS 18
Descriptive statistics variations among categories of Gps navigation where relevant

2. Semi-Structured Interviews: NVivo
Constant comparison technique
Open coding, axial coding, selective coding
Build theoretical knowledge of Gps navigation experiential understanding

Contribution
Original data / Mixed method
Experiential understanding from Gps navigation (under-researched)
Physician solutions for primary care challenges

Improve uptake of brief interventions/screening in GP practices
Address geographic disparities in harm/health

Strongly related current initiatives to:
Questions
Manuscript 2
*Geographical (space/place) orientation
* Regional / urban+rural variations