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

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.

In Support of Overdose Prevention Centers: Position Statement of AMERSA, Inc (Association for Multidisciplinary Education and Research in Substance Use and Addiction)

“…61-63 Given that OPCs are healthcare settings with trained staff, these environments are well positioned to address the medical consequences of an unpredictable drug supply; this is especially important for people who might not be able to access—or might feel uncomfortable in—traditional medical settings due to established barriers such as the cost of care, anticipated stigma, and access to health insurance. 64,65 In addition, OPCs can provide broader health and wellness services to clients such as food, clothing, and showers. 15,64…”

Understanding healthcare engagement for people who inject drugs

“…Authors from one systematic review showed that PWID utilize emergency department services 4.8 times more than the general population, with multiple studies showing injection drug use as a strong predictive factor of increased ED visits (Kendall et al, 2017; Lewer et al, 2020; Nambiar et al, 2017). In another systematic review younger age, incarceration, homelessness, lack of health insurance, and poor provider continuity are associated with decreased engagement in primary care for PWID (Heidari et al, 2023), while visits with a primary care provider (PCP) and receipt of MOUD are strong protective factors against ED utilization (Kendall et al, 2017).…”

Sociocultural and contextual influences on mental health

“…Various studies included in this special issue address substance abuse among different age and cultural groups. These included studies focused on alcohol and substance use among Native American youth in the United States (Lowe et al, 2024), tobacco and alcohol co‐use among college graduates in Spain (Neddermann‐Carrillo et al, 2024), and people who inject drugs (PWID) in the United States (Heidari et al, 2023). Taken together, these studies highlight unique challenges and opportunities for addressing substance abuse across the lifespan and through a multitude of community‐based and healthcare responses.…”

“…The observational research reported among adult college graduates from the “Seguimiento Universidad de Navarra” (SUN) cohort study in Spain ( n = 7175) (Neddermann‐Carrillo et al, 2024) and qualitative research with PWID (Heidari et al, 2023) help identify opportunities for interventions. Findings from SUN highlight important demographic, behavioral factors, and personality factors that can be used to identify sub‐populations at the highest risk for alcohol and tobacco co‐use (e.g., more frequent coffee drinkers) and protective characteristics that can be leveraged (e.g., promoting physical activity).…”

“…Findings from SUN highlight important demographic, behavioral factors, and personality factors that can be used to identify sub‐populations at the highest risk for alcohol and tobacco co‐use (e.g., more frequent coffee drinkers) and protective characteristics that can be leveraged (e.g., promoting physical activity). Findings from interviews with 24 PWIDs further highlight the importance of healthcare responses to include wrap‐around services that build on strong patient‐provider relationships and integrate substance abuse, mental health, physical health, social needs, and harm reduction approaches (Heidari et al, 2023).…”