Barriers and facilitators to primary care engagement for people who inject drugs: A systematic review

Authors

Omeid Heidari, Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Washington, Seattle, USA.
Kayla Tormohlen, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Maryland, Baltimore, USA.
Derek T. Dangerfield, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, District of Columbia, Washington, USA.
Karin E. Tobin, Department of Health, Behavior, and Society. Bloomberg School of Public Health, Johns Hopkins University, Maryland, Baltimore, USA.
Jason E. Farley, Center for Infectious Disease and Nursing Innovation, School of Nursing, Johns Hopkins University, Maryland, Baltimore, USA.
Shoshana V. Aronowitz, Department of Family and Community Health, School of Nursing, University of Pennsylvania, Pennsylvania, Philadelphia, USA.

Document Type

Journal Article

Publication Date

12-8-2022

Journal

Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing

DOI

10.1111/jnu.12863

Keywords

HIV/AIDS; advanced practice nursing; health disparities; infectious diseases; primary health care; substance use

Abstract

INTRODUCTION: People who inject drugs (PWID) have a greater burden of multimorbid chronic diseases than the general population. However, little attention has been paid to the engagement in primary care for services related specifically to injection drug use and management of underlying chronic comorbid diseases for this population. This systematic review identified facilitators and barriers to healthcare engagement in the primary care setting among PWID. DESIGN AND METHODS: Studies were identified by a literature search of PubMed, CINAHL, and EMBASE, and by searching the references of retrieved articles. Studies were included if they measured active injection drug use, and outcomes related to primary care engagement characterized by: diagnosis of a health condition, linkage or retention in care, health condition-related outcomes, and reported patient-provider relationship. RESULTS: Twenty-three articles were included. Using the behavioral model, factors within predisposing, enabling, need, and health behavior domains were identified. Having co-located services and a positive patient-provider relationship were among the strongest factors associated with healthcare utilization and engagement while active injection drug use was associated with decreased engagement. CONCLUSIONS: To our knowledge, this is the only review of evidence that has examined factors related to primary care engagement for people who inject drugs. Most articles were observational studies utilizing descriptive designs. Although the assessment of the evidence was primarily rated 'Good', this review identifies a significant need to improve our understanding of primary care engagement for PWID. Future research and intervention strategies should consider these findings to better integrate the holistic care needs of PWID into primary care to reduce morbidity and mortality associated with injection drug use and chronic disease. CLINICAL RELEVANCE: Primary care engagement is important for preventative care, early diagnosis of disease, and management of chronic diseases, including addressing problems of substance use. This review highlights factors nurses can utilize to facilitate primary care engagement of PWID.

APA Citation

Heidari, Omeid; Tormohlen, Kayla; Dangerfield, Derek T.; Tobin, Karin E.; Farley, Jason E.; and Aronowitz, Shoshana V., "Barriers and facilitators to primary care engagement for people who inject drugs: A systematic review" (2022). GW Authored Works. Paper 2126.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2126

Department

Prevention and Community Health