|Institution:||University of Victoria|
|Keywords:||health care; British Columbia; health geography; alcohol; rural health|
|Full text PDF:||http://hdl.handle.net/1828/5841|
In recent years there has been a renewed focus on reducing the harms of addictive substances such as alcohol while at the same time restraining or reducing health care costs. To address these issues, and many of the existing limitations in the literature, the purpose of this dissertation was to improve our understanding of the geography of alcohol-related harm, and use of primary health care services for alcohol-attributed diseases in British Columbia (BC). To achieve this purpose, there were three research objectives that guided the research that comprises this dissertation: Objective 1: Measure regional variations and trends in primary health care utilization in BC for alcohol-attributed diseases across time (2001-2011) and space (Health Service Delivery Areas) (Studies A & D); Objective 2: Describe primary health care physician experiences treating persons with alcohol-attributed diseases in rural communities that are isolated and sparsely populated with minimal access to secondary or tertiary level services (Study B), and Objective 3: Develop a methodology to describe the geography of alcohol-related harm in BC to identify regions that have populations who may have elevated risk for the development of alcohol-attributed diseases (Study C). Administrative health data were used in Studies A and D to examine trends in health care utilization by persons with alcohol-attributed diseases from 2001-2011 based on disease type and geography (Health Services Delivery Areas). Building on these results, Study B examines family physician experiences treating persons with alcohol-related issues in rural places. To further understand regional variations in alcohol-related issues, an index of alcohol-related harm (Study C) was created using a variety of data that are correlated to alcohol-related problems at the population level, including morbidity, mortality, and alcohol consumption data. The results of this dissertation research highlight regional variations in alcohol-related harm and primary health care use for alcohol-related illnesses – as well as significant growth in alcohol-attributed disease cases in BC since 2001. These findings demonstrate the importance of where we live to risk of developing alcohol-attributed diseases and access to treatment. The results of this dissertation suggest that less populated areas of BC are disproportionately affected by alcohol-related problems and there are additional barriers to care for persons from rural areas. Based on the increasing number of alcohol-attributed disease cases, and the large regional variations in alcohol-related harm found in this project, alcohol-related health problems are an emerging and significant population health challenge for BC.