Access to healthcare among managed alcohol program participants: A mixed methods study

Managed alcohol programs (MAPs) offer safe and regulated doses of alcohol to individuals with high-risk drinking behaviours unresponsive to other treatments. These harm reduction programs aim to reduce alcohol-related harms and increase access to housing, health, and social services. In our study we aimed to understand the impacts of MAP participation on access to healthcare. Using a mixed methods design, we analyzed data collected in six Canadian cities between 2014 and 2017. Data sources included surveys from MAP participants (n = 188) and locally recruited and matched control participants (n = 198), and semi-structured interviews with MAP participants (n = 56). In the quantitative cross-sectional analysis, MAP participants were more likely to report regular (OR 1.77 [1.02 - 3.07]) and satisfactory (OR 2.02 [1.04 - 3.91]) access to healthcare compared to controls. We identified variable findings in access to healthcare between a subset of MAP (n = 82) and control (n = 116) participants with 12-month longitudinal follow-up data; however, when MAP participants were on the program, they had an increased likelihood of reporting regular (OR 2.16 [1.04 - 4.48]) and satisfactory (OR 3.23 [1.09 - 9.54]) access to healthcare compared to when they were off the program. Themes generated from the qualitative analysis illustrated the services offered within and alongside MAPs, the impacts of the MAP environment on access to healthcare, and the time needed to develop trusting relationships and address complex needs. These findings highlight the importance of long-term supportive care to improve access to healthcare among those experiencing homelessness and alcohol use disorders.