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Access to and waiting time for psychiatrist services in a Canadian urban area: a study in real time.

https://arctichealth.org/en/permalink/ahliterature131782
Source
Can J Psychiatry. 2011 Aug;56(8):474-80
Publication Type
Article
Date
Aug-2011
Author
Elliot M Goldner
Wayne Jones
Mei Lan Fang
Author Affiliation
Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia. egoldner@sfu.ca
Source
Can J Psychiatry. 2011 Aug;56(8):474-80
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Adult
British Columbia
Cognitive Therapy - statistics & numerical data
Female
Health Care Surveys
Health Services Accessibility - statistics & numerical data
Humans
Male
Mental Health Services - statistics & numerical data
Psychiatry - statistics & numerical data
Referral and Consultation - statistics & numerical data
Time Factors
Urban Population - statistics & numerical data
Waiting Lists
Abstract
To obtain improved quality information regarding psychiatrist waiting times by use of a novel methodological approach in which accessibility and wait times are determined by a real-time patient referral procedure.
An adult male patient with depression was referred for psychiatric assessment by a family physician. Consecutive calls were made to all registered psychiatrists (n = 297) in Vancouver. A semistructured call procedure was used to collect information about the psychiatrists' availability for receipt of this and similar referrals, identify factors that affect psychiatrist accessibility, and determine the availability of cognitive-behavioural therapy (CBT).
Efforts were made to contact 297 psychiatrists and 230 (77%) were reached successfully. Among the 230 psychiatrists contacted, 160 (70%) indicated that they were unable to accept the referral. Although 70 (30%) indicated that they might be able to consider accepting a referral, 64 (91% of those who would consider accepting the referral) indicated that they would need to review detailed, written referral information and could not provide estimates of the length of wait times if the patient was to be accepted. Only 6 (3% of the 230 psychiatrists contacted) offered immediate appointment times and their wait times ranged from 4 to 55 days. When asked whether they could provide CBT, most (56%) psychiatrists in clinical practice answered maybe.
Substantial barriers exist for family physicians attempting to refer patients for psychiatric referral. Consolidated efforts to improve access to psychiatric assessment are needed.
PubMed ID
21878158 View in PubMed
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Adolescent psychosis risk symptoms predicting persistent psychiatric service use: A 7-year follow-up study.

https://arctichealth.org/en/permalink/ahliterature298906
Source
Eur Psychiatry. 2019 01; 55:102-108
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
01-2019
Author
Maija Lindgren
Minna Jonninen
Markus Jokela
Sebastian Therman
Author Affiliation
Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland. Electronic address: maija.lindgren@thl.fi.
Source
Eur Psychiatry. 2019 01; 55:102-108
Date
01-2019
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Female
Finland - epidemiology
Follow-Up Studies
Humans
Male
Mental Disorders - epidemiology - therapy
Mental Health Services - statistics & numerical data
Patient Acceptance of Health Care - statistics & numerical data
Prodromal Symptoms
Prognosis
Prospective Studies
Psychiatric Status Rating Scales
Psychopathology
Psychotic Disorders - diagnosis - epidemiology - psychology
Risk Assessment - methods
Risk factors
Utilization Review - statistics & numerical data
Abstract
We investigated whether psychosis risk symptoms predicted psychiatric service use using seven-year register follow-up data.
Our sample included 715 adolescents aged 15-18, referred to psychiatric care for the first time. Psychosis risk symptoms were assessed with the Prodromal Questionnaire (PQ) at the beginning of the treatment. We assessed the power of the overall PQ as well as its positive, negative, general, and disorganized psychosis risk symptom factors in predicting prolonged service use. Baseline psychiatric diagnoses (grouped into 7 categories) were controlled for. Based on both inpatient and outpatient psychiatric treatment after baseline, adolescents were divided into three groups of brief, intermittent, and persistent service use.
Stronger symptoms on any PQ factor as well as the presence of a mood disorder predicted prolonged service use. All of the PQ factors remained significant predictors when adjusted for baseline mood disorder and multimorbidity.
In a prospective follow-up of a large sample using comprehensive mental health records, our findings indicate that assessing psychosis risk symptoms in clinical adolescent settings at the beginning of treatment could predict long-term need for care beyond diagnostic information. Our findings replicate the previous findings that positive psychosis risk symptoms are unspecific markers of severity of psychopathology. Also psychosis risk symptoms of the negative, disorganization, and general clusters are approximately as strongly associated with prolonged psychiatric service use in the upcoming years.
PubMed ID
30447416 View in PubMed
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Adolescent school absenteeism and service use in a population-based study.

https://arctichealth.org/en/permalink/ahliterature269789
Source
BMC Public Health. 2015;15:626
Publication Type
Article
Date
2015
Author
Kristin Gärtner Askeland
Siren Haugland
Kjell Morten Stormark
Tormod Bøe
Mari Hysing
Source
BMC Public Health. 2015;15:626
Date
2015
Language
English
Publication Type
Article
Keywords
Absenteeism
Adolescent
Adolescent Behavior
Cross-Sectional Studies
Female
Health Behavior
Health Services - statistics & numerical data - utilization
Humans
Male
Mental Health Services - statistics & numerical data - utilization
Norway
Peer Group
Risk-Taking
Student Dropouts
Students - statistics & numerical data
Surveys and Questionnaires
Abstract
School absenteeism is linked to a range of health concerns, health risk behaviors and school dropout. It is therefore important to evaluate the extent to which adolescents with absenteeism are in contact with health care and other services. The aim of the current study was to investigate service use of Norwegian adolescents with moderate and high absenteeism in comparison to students with lower rates of absence.
The study employs data from a population-based study from 2012 targeting all pupils in upper secondary education in Hordaland County, Norway (the youth@hordaland-survey). A total of 8988 adolescents between the ages of 16 and 18 were included in the present study. Information on service use was based on adolescent self-report data collected in the youth@hordaland-survey. Absence data was collected using administrative data provided by the Hordaland County Council.
High absence (defined as being absent 15% or more the past semester) was found among 10.1% of the adolescents. Compared to their peers with low absence (less than 3% absence the past semester), adolescents with high absence were more likely to be in contact with all the services studied, including mental health services (odds ratio (OR) 3.96), adolescent health clinics (OR 2.11) and their general practitioner (GP) (OR 1.94). Frequency of contact was higher among adolescents with moderate and high absence and there seems to be a gradient of service use corresponding to the level of absence. Still, 40% of the adolescents with high absence had not been in contact with any services.
Adolescents with high absence had increased use of services, although a group of youth at risk seems to be without such contact. This finding suggests a potential to address school absenteeism through systematic collaboration between schools and health personnel.
Notes
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PubMed ID
26155938 View in PubMed
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[Ambulatory psychiatry--a follow-up after 1 year]

https://arctichealth.org/en/permalink/ahliterature73352
Source
Ugeskr Laeger. 1993 May 10;155(19):1464-8
Publication Type
Article
Date
May-10-1993
Author
T. Mahneke
V. Dragsted
P S Jensen
S B Larsen
B. Meidahl
B. Rosenbaum
Author Affiliation
Roskilde Amts Sygehus Fjorden.
Source
Ugeskr Laeger. 1993 May 10;155(19):1464-8
Date
May-10-1993
Language
Danish
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Ambulatory Care Facilities - statistics & numerical data
Denmark
English Abstract
Female
Follow-Up Studies
Humans
Male
Mental Disorders - diagnosis - psychology - therapy
Mental Health Services - statistics & numerical data
Middle Aged
Outpatient clinics, hospital - statistics & numerical data
Prospective Studies
Psychiatric Department, Hospital - statistics & numerical data
Referral and Consultation - statistics & numerical data
Research Support, Non-U.S. Gov't
Abstract
This article describes the results of a one year follow-up investigation of patients suffering from psychiatric and mental diseases and psycho-social problems who were seen in general practice or by private practising psychiatrists and the psychiatric outpatient hospital clinic in a Danish county. 40-50% of the patients concluded treatment within the first year. The general practitioner and the private practising psychiatrist saw 10% of the patients more than 13 times. In the outpatient hospital clinic, 10% of the patients were seen more than 29 times. A psychotherapeutic approach to treatment was employed for 54-90% of the cases. Psychopharmacological medication was administered to 54-60% of the patients. Where patients in general practice and in the outpatient clinic were concerned, treatment in an emergency open unit and treatment in sheltered environments was required and supervision was necessary for 1/4 of the cases. The investigation demonstrates the role of the general practitioner in treatment and referral. After one year 25% of the patients were referred for other treatment. The general practitioner, private practicing psychiatrist and outpatient clinic treat different groups of psychiatric patients and work somewhat independently of one another.
PubMed ID
8316974 View in PubMed
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An engagement and access model for healthcare delivery to adolescents with mood and anxiety concerns.

https://arctichealth.org/en/permalink/ahliterature128740
Source
Early Interv Psychiatry. 2012 Feb;6(1):97-105
Publication Type
Article
Date
Feb-2012
Author
Erin Ross
Evelyn Vingilis
Elizabeth Osuch
Author Affiliation
FEMAP, London, Canada.
Source
Early Interv Psychiatry. 2012 Feb;6(1):97-105
Date
Feb-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adolescent Health Services - statistics & numerical data
Adult
Anxiety Disorders - diagnosis - therapy
Community-Institutional Relations
Female
Health Services Accessibility - statistics & numerical data
Humans
Male
Mental Health Services - statistics & numerical data
Mood Disorders - diagnosis - therapy
Ontario
Program Evaluation - methods - statistics & numerical data
Abstract
Mood and anxiety disorders typically begin during adolescence or early adulthood. Yet services targeting this population are frequently lacking. This study implemented an outreach, access and assessment programme for youth with these concerns. The data reported constitute an evaluation of this mental healthcare delivery approach.
This evaluation included specification of both programme and implementation theories through causal and programme logic models and formative (process) evaluation. Outreach focused on access points for youth such as schools and family physicians' offices. Concerned youth were encouraged to self-refer. Participants completed a semi-structured clinical interview and symptom and function questionnaire package.
Engagement sessions were conducted and results involved 93 youth. The majority of youth self-referred, a process not possible in traditional physician-referral healthcare systems. Interestingly, almost half had received prior treatment and over half had tried a psychiatric medication. Yet participants had significant symptomatology: 81% reported moderate to severe depressive symptoms; 95% reported high levels of trait-anxiety. Functional impairment was substantial: on average, participants missed 2.6 days of school/work and functioned at reduced levels on 4.2 days in the week prior to assessment. Demographic details are presented.
This study evaluated a mental healthcare delivery system that identified individuals with significant distress and functional impairment from mood/anxiety concerns and previous unsuccessful treatment attempts, verifying that they were in need of mental health services. This approach provides a model for outreach and assessment in this population, where earlier intervention has the potential to prevent chronic mental illness and disability.
PubMed ID
22171651 View in PubMed
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Assessment and treatment of asylum seekers after a suicide attempt: a comparative study of people registered at mental health services in a Swedish location.

https://arctichealth.org/en/permalink/ahliterature271105
Source
BMC Psychiatry. 2015;15:235
Publication Type
Article
Date
2015
Author
Maria Sundvall
Dag H Tidemalm
David E Titelman
Bo Runeson
Sofie Bäärnhielm
Source
BMC Psychiatry. 2015;15:235
Date
2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Case-Control Studies
Female
Humans
Male
Mental Disorders - epidemiology - psychology - therapy
Mental health
Mental Health Services - statistics & numerical data
Middle Aged
Psychological Trauma - epidemiology - psychology
Refugees - psychology - statistics & numerical data
Risk factors
Suicidal ideation
Suicide, Attempted - psychology - statistics & numerical data
Sweden - epidemiology
Abstract
Even though asylum seekers are considered vulnerable to mental ill-health, knowledge of their suicidal behaviour is limited. The aim of this study was to improve our understanding of factors that influence the clinical assessment of asylum seekers who have attempted suicide compared to the assessment of non-asylum seekers.
The study focused on 88 asylum seekers registered for suicide attempts in mental health services 2005-2009, who were matched for age and gender and compared with 88 suicide attempters with Swedish personal identity numbers. The medical records were analysed with a quantitative protocol, focusing on social risk and protective factors, health history, current clinical picture as well as the assessment procedure, diagnostics, patterns of treatment and follow-up in this clinical group. Data was analysed using the chi-square test, Fisher's exact probability test, and the Mann-Whitney U test.
As in earlier studies, asylum seekers were more traumatized, had different social risk factors and received different diagnoses than the controls. Asylum seekers were referred to less specialized follow-up after treatment, in spite of their health history and of previous and current clinical pictures indicating a similar or--in the case of the female asylum seekers--more serious mental health condition. Female asylum seekers also received more intense and prolonged in-patient treatment than female controls. Asylum seekers appeared to have social networks more often than the control group. However, there was less documentation of the social context, previous suicidal behaviour, and on suicide in the family and close environment of the asylum-seeking men. Information on suicidal intent was lacking in a majority of both groups. The time relation of the suicide attempt and the asylum process suggested the importance of the asylum decision, as well as the possible role of earlier mental health problems and premigration stress, for the suicidal behaviour.
The groups had different sets of risk factors and clinical pictures. There was a lack of early and thorough exploration of suicide intent for both groups, and of contextual and subjective factors for the asylum seekers. Differences in follow-up indicate unequal access to care.
Notes
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PubMed ID
26446409 View in PubMed
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Assessment of service needs of adult psychiatric inpatients: a systematic approach.

https://arctichealth.org/en/permalink/ahliterature208950
Source
Psychiatr Q. 1997;68(1):5-23
Publication Type
Article
Date
1997
Author
S S Kazarian
S B McCabe
L W Joseph
Author Affiliation
London Psychiatric Hospital, ON, Canada.
Source
Psychiatr Q. 1997;68(1):5-23
Date
1997
Language
English
Publication Type
Article
Keywords
Activities of Daily Living - classification
Adolescent
Adult
Aged
Community Mental Health Services - statistics & numerical data
Female
Health Services Needs and Demand - statistics & numerical data
Hospitals, Psychiatric
Hospitals, Public
Humans
Male
Mental Disorders - diagnosis - epidemiology - rehabilitation
Middle Aged
Ontario
Patient Admission - statistics & numerical data
Patient Discharge - statistics & numerical data
Abstract
In this study, a systematic needs-assessment approach to evaluating the institutional and community service requirements of adult psychiatric inpatients is reported. The Community Placement Questionnaire (CPQ) was completed by professional staff on all patients between the ages of 18-65 residing in a publicly-funded psychiatric hospital. Of the 105 patients surveyed, 65.7% were considered potentially hard to place in the community (6.7% were nominated for permanent placement in the institution), and 34.3% were considered easy to place. The findings indicate that successful planning for community-based mental health services requires the four essential elements of the protected hospital environment, treatment, augmentation in psychosocial rehabilitation programming and availability of supports and services in the community. Specific strategies for transition from institutional-based care to community care are discussed.
PubMed ID
9021838 View in PubMed
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Association of Bullying Behavior at 8 Years of Age and Use of Specialized Services for Psychiatric Disorders by 29 Years of Age.

https://arctichealth.org/en/permalink/ahliterature274021
Source
JAMA Psychiatry. 2016 Feb;73(2):159-65
Publication Type
Article
Date
Feb-2016
Author
Andre Sourander
David Gyllenberg
Anat Brunstein Klomek
Lauri Sillanmäki
Anna-Marja Ilola
Kirsti Kumpulainen
Source
JAMA Psychiatry. 2016 Feb;73(2):159-65
Date
Feb-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Bullying - statistics & numerical data
Child
Crime Victims - statistics & numerical data
Female
Finland - epidemiology
Follow-Up Studies
Humans
Male
Mental Disorders - epidemiology - etiology
Mental Health Services - statistics & numerical data - utilization
Registries - statistics & numerical data
Young Adult
Abstract
Bullying and being exposed to bullying among children is prevalent, especially among children with psychiatric symptoms, and constitutes a major concern worldwide. Whether childhood bullying or exposure to bullying in the absence of childhood psychiatric symptoms is associated with psychiatric outcomes in adulthood remains unclear.
To study the associations between bullying behavior at 8 years of age and adult psychiatric outcomes by 29 years of age.
Nationwide birth cohort study of 5034 Finnish children with complete information about childhood bullying behavior was followed up from 8 to 29 years of age. Follow-up was completed on December 31, 2009, and data were analyzed from January 15, 2013, to February 15, 2015.
Information about bullying, exposure to bullying, and psychiatric symptoms were obtained from parents, teachers, and child self-reports when children were 8 years of age. Use of specialized services for psychiatric disorders from 16 to 29 years of age was obtained from a nationwide hospital register, including outpatient and inpatient treatment.
Among the 5034 study participants, 4540 (90.2%) did not engage in bullying behavior; of these, 520 (11.5%) had received a psychiatric diagnosis at follow-up; 33 of 166 (19.9%) who engaged in frequent bullying, 58 of 251 (23.1%) frequently exposed to bullying, and 24 of 77 (31.2%) who both frequently engaged in and were frequently exposed to bullying had received psychiatric diagnoses at follow-up. When analyses were adjusted by sex, family factors, and child psychiatric symptoms at 8 years of age, we found independent associations of treatment of any psychiatric disorder with frequent exposure to bullying (hazard ratio [HR], 1.9; 95% CI, 1.4-2.5) and being a bully and exposed to bullying (HR, 2.1; 95% CI, 1.3-3.4). Exposure to bullying was specifically associated with depression (HR, 1.9; 95% CI, 1.2-2.9). Bullying was associated with psychiatric outcomes only in the presence of psychiatric problems at 8 years of age. Participants who were bullies and exposed to bullying at 8 years of age had a high risk for several psychiatric disorders requiring treatment in adulthood. However, the associations with specific psychiatric disorders did not remain significant after controlling for concurrent psychiatric symptoms.
Exposure to bullying, even in the absence of childhood psychiatric symptoms, is associated with severe adulthood psychiatric outcomes that require treatment in specialized services. Early intervention among those involved in bullying can prevent long-term consequences.
PubMed ID
26650586 View in PubMed
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[A study of risk factors for cardiovascular disease among schizophrenic patients using the rehabilitation mental health services at Kleppur].

https://arctichealth.org/en/permalink/ahliterature121017
Source
Laeknabladid. 2012 Jul;98(7-8):399-402
Publication Type
Article
Date
Jul-2012
Author
Olafur Sveinsson
Kristofer Thorleifsson
Thor Aspelund
Halldor Kolbeinsson
Author Affiliation
Endurhæfingardeildir Gedsvids ad Kleppi, Landspitala. olafur.sveinsson@karolinska.se
Source
Laeknabladid. 2012 Jul;98(7-8):399-402
Date
Jul-2012
Language
Icelandic
Geographic Location
Canada
Publication Type
Article
Keywords
Biological Markers - blood
Blood Glucose - metabolism
Blood pressure
Body mass index
Cardiovascular Diseases - blood - diagnosis - epidemiology - physiopathology - prevention & control
Diabetes Mellitus - diagnosis - epidemiology
Dyslipidemias - diagnosis - epidemiology
Female
Health status
Humans
Hypertension - diagnosis - epidemiology
Iceland - epidemiology
Male
Mental Health Services - statistics & numerical data
Metabolic Syndrome X - diagnosis - epidemiology
Obesity - diagnosis - epidemiology
Prevalence
Risk assessment
Risk factors
Schizophrenia - diagnosis - epidemiology
Waist Circumference
Abstract
Studies have shown that schizophrenic patients die on average 15-20 years earlier than the normal population, and that increased prevalance of cardiovascular risk factors plays a crucial role Schizophrenic patients are underdiagnosed and undertreated when it comes to diabetes, hypertension and dyslipidemia. The aim of this study was to investigate the prevalence of metabolic syndrome, obesity, hypertension, diabetes and dyslipidemia among schizophrenic patients in Iceland.
An observational study of 106 schizophrenic patients in Iceland during the period 2007-2009. The results were compared to age adjusted population based data.
106 patients participated, 86 men and 20 women. In all 57% were diagnosed with metabolic syndrome (p30 kg/m²). Only 32.1% had normal BMI, and 82.1% had waist circumference over the normal limits.
The physical condition of Icelandic schizophrenic patients is poor and their risk for cardiovascular diseases is high. It is necessary to follow their weight, blood pressure, blood glucose and lipids more closely It is imperative to educate and enable the schizophrenic patient to live a healthier life.
PubMed ID
22947605 View in PubMed
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Attendance, drug use patterns, and referrals made from North America's first supervised injection facility.

https://arctichealth.org/en/permalink/ahliterature171504
Source
Drug Alcohol Depend. 2006 Jul 27;83(3):193-8
Publication Type
Article
Date
Jul-27-2006
Author
Mark W Tyndall
Thomas Kerr
Ruth Zhang
Evelyn King
Julio G Montaner
Evan Wood
Author Affiliation
Department of Medicine, and BC Centre for Excellence in HIV/AIDS, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada. mtyndall@cfenet.ubc.ca
Source
Drug Alcohol Depend. 2006 Jul 27;83(3):193-8
Date
Jul-27-2006
Language
English
Publication Type
Article
Keywords
Acquired Immunodeficiency Syndrome - epidemiology - ethnology - prevention & control - psychology
Adult
British Columbia
Cocaine-Related Disorders - epidemiology - ethnology - psychology - rehabilitation
Community Mental Health Services - statistics & numerical data
Cross-Sectional Studies
Drug Overdose - epidemiology - ethnology - prevention & control - psychology
Female
HIV Infections - epidemiology - ethnology - psychology
Health Services Needs and Demand - statistics & numerical data
Heroin Dependence - epidemiology - ethnology - psychology - rehabilitation
Humans
Male
Needle Sharing - adverse effects - statistics & numerical data - trends
Patient Acceptance of Health Care - psychology - statistics & numerical data
Population Groups - psychology - statistics & numerical data
Referral and Consultation - statistics & numerical data
Street Drugs - poisoning
Substance Abuse Treatment Centers - organization & administration - utilization
Substance Abuse, Intravenous - epidemiology - ethnology - psychology - rehabilitation
Utilization Review - statistics & numerical data
Abstract
North America's first government sanctioned supervised injection facility (SIF) was opened in Vancouver in response to the serious health and social consequences of injection drug use and the perseverance of committed advocates and drug user groups who demanded change. This analysis was conducted to describe the attendance, demographic characteristics, drug use patterns, and referrals made during the first 18 months of operation.
As part of the evaluation strategy for the SIF, information is collected through a comprehensive on-site database designed to track attendance and the daily activities within the facility. All users of the SIF must sign a waiver form and are then entered into a database using a unique identifier of their choice. This identifier is used at each subsequent visit to provide a prospective record of attendance, drug use, and interventions.
From 10 March 2004 to 30 April 2005 inclusive, there were 4764 unique individuals who registered at the SIF. The facility successfully attracted a range of community injection drug users including women (23%) and members of the Aboriginal community (18%). Although heroin was used in 46% of all injections, cocaine was injected 37% of the time. There were 273 witnessed overdoses with no fatalities. During just 12 months of observation, 2171 individual referrals were made with the majority (37%) being referred for addiction counseling.
Vancouver's SIF has successfully been integrated into the community, has attracted a wide cross section of community injection drug users, has intervened in overdoses, and initiated over 2000 referrals to counseling and other support services. These findings should be useful for other settings considering SIF trials.
PubMed ID
16356659 View in PubMed
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121 records – page 1 of 13.