Medical professionals adequately trained to prevent and treat substance use disorders are in short supply in most areas of the world. Whereas physician training in addiction medicine can improve patient and public health outcomes, the coverage estimates have not been established. We estimated the extent of the need for medical professionals skilled in addiction medicine in a Canadian setting.
We used Monte-Carlo simulations to generate medians and 95% credibility intervals for the burden of alcohol and drug use harms, including morbidity and mortality, in British Columbia, by geographic health region. We obtained prevalence estimates for the models from the Medical Services Plan billing, the Discharge Abstract Database data, and the government surveillance data. We calculated a provider availability index (PAI), a ratio of the size of the labor force per 1000 affected individuals, for each geographic health region, using the number of American Board of Addiction Medicine certified physicians in each area.
Depending on the data source used for population estimates, the availability of specialized addiction care providers varied across geographic health regions. For drug-related harms, we found the highest PAI of 23.72 certified physicians per 1000 affected individuals, when using the Medical Services Plan and Discharge Abstract Database data. Drawing on the surveillance data, the drug-related PAI dropped to 0.46. The alcohol-related PAI ranged between 0.10 and 86.96 providers, depending on data source used for population estimates.
Our conservative estimates highlight the need to invest in healthcare provider training and to develop innovative approaches for more rural health regions.
BC Centre for Excellence in HIV/AIDS (JM, KA, SN, AM, EW, JK), St. Paul's Hospital; School of Population and Public Health (EW), University of British Columbia; Department of Medicine (JK), University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada; School of Medicine and Medical Science (JK), University College Dublin, Coombe Healthcare Centre, Dolphins barn, Dublin, Ireland; Department of Family Practice (KA, SN, AM), University of British Columbia, St. Paul's Hospital, Department of Family and Community Medicine; and Raven Song Community Health Centre (JM), Vancouver, BC, Canada.
Send correspondence and reprint requests to Jan Klimas, MSc, PhD, Urban Health Research Initiative, B.C. Centre for Excellence in HIV/AIDS, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada. E-mail: firstname.lastname@example.org.
Received 21 January, 2016
Accepted 21 April, 2016
Authors’ contributions: JM collected and analyzed all data. JK was a Postdoctoral Fellow and supervised the study. EW was his Mentor, and conceived the study. JK and JM led preparation of the manuscript with feedback from all co-authors. KA, SN, and AM contributed to the study design, focus group guide, and/or facilitated access to participants. All authors read and approve the final manuscript.
Funding: This research was also undertaken, in part, by funding from the Canada Research Chairs program through a Tier 1 Canada Research Chair in Inner City Medicine, and by the US National Institutes of Health (R25DA037756) that supports Dr. Evan Wood. The ELEVATE grant: Irish Research Council International Career Development Fellowship, co-funded by Marie Cure Actions (ELEVATEPD/2014/6); and the Marie Sklodowska Curie Fellowship (701698) supports Dr. Jan Klimas.
The authors report no conflicts of interest.