Abstract
The purpose of this study was to examine geographic variations in primary health care utilization for diseases wholly attributed to alcohol consumption using physician billing data from British Columbia (BC), Canada. Data was modeled by Health Service Delivery Area (HSDA) (N = 16) and Health Authority (N = 5) to examine geographic variations in general practitioner (GP) consultations by persons with alcohol-attributed diseases from 2001 to 2011. Data was modeled by the count of cases per 10,000 residents per year by HSDA, and incidence rate ratios were calculated using negative binomial regression to determine the significance of yearly variations in cases by HSDA. The frequency of utilization was calculated to measure yearly changes in the intensity of primary health care service use by patient. From January 1, 2001 to December 31, 2011 there were 690,401 visits to GPs by 198,623 persons with an alcohol-attributed disease in BC. After the deletion of records with missing HSDA data, the final sample was comprised of 676,515 visits by 192,333 persons. Over the ten-year period, there was a significant increase in the number of alcohol-attributed disease cases per 10,000 seen by GPs at the provincial level, from 34.9 in 2001 to 48.2 per 10,000 in 2011. Urban areas of the province had the greatest crude number of visits to GPs for alcohol-attributed diseases; however, rural and northern HSDAs had the highest per capita consultations. A larger proportion of alcohol-attributed disease visits occurred in emergency room and inpatient hospital settings in rural and northern areas. Since 2001 there have been significant increases in the rates of alcohol-attributed disease cases in all Health Authorities. Rural and northern areas of BC had above average rates of GP utilization for alcohol-attributed diseases. The results of this study show that alcohol-related harms are both a regional and provincial issue for health care planning.
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