Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
J Gen Intern Med. 2021 Jul;36(7):1898-1905. doi: 10.1007/s11606-020-06409-6. Epub 2021 Jan 19.
Stigma is a barrier to the uptake of buprenorphine to treat opioid use disorder. Harm reduction treatment models intend to minimize this stigma by organizing care around non-judgmental interactions with people who use drugs. There are few examples of implementing buprenorphine treatment using a harm reduction approach in a primary care setting in the USA.
We conducted a qualitative study by interviewing leadership, staff, and external stakeholders at Respectful, Equitable Access to Compassionate Healthcare (REACH) Medical in Ithaca, NY. REACH is a freestanding medical practice that provides buprenorphine treatment for opioid use disorder since 2018. We conducted semi-structured interviews with 17 participants with the objective of describing REACH's model of care. We selected participants based on their position at REACH or in the community. Interviews were recorded, transcribed, and analyzed for themes using content analysis, guided by the CDC Evaluation Framework.
REACH provided buprenorphine, primary care, and mental health services in a low-threshold model. We identified three themes related to delivery of buprenorphine treatment. First, an organizational mission to provide equitable and low-stigma healthcare, which was a key to organizational identity. Second, a low-threshold buprenorphine treatment approach that was critical, but caused concern about over-prescribing and presented logistical challenges. Third, creation and retention of a harm reduction-oriented workforce by offering value-based work and by removing administrative barriers providers may face elsewhere to providing buprenorphine treatment.
A harm reduction primary care model can help reduce stigma for people who use drugs and engage in buprenorphine treatment. Further research is needed to evaluate whether this model leads to improved patient outcomes, can overcome community stakeholder concerns, and is sustainable.
污名化是阻碍使用丁丙诺啡治疗阿片类药物使用障碍的一个因素。减少伤害治疗模式旨在通过围绕与吸毒者进行无评判的互动来组织护理，从而最大限度地减少这种污名化。在美国，在初级保健环境中采用减少伤害方法实施丁丙诺啡治疗的例子很少。
我们在纽约伊萨卡的尊重、公平获得同情医疗保健（REACH）医疗中心进行了一项定性研究，对领导层、工作人员和外部利益相关者进行了访谈。REACH 是一家独立的医疗实践机构，自 2018 年以来一直为阿片类药物使用障碍提供丁丙诺啡治疗。我们对 17 名参与者进行了半结构化访谈，目的是描述 REACH 的护理模式。我们根据他们在 REACH 或社区中的职位选择了参与者。访谈以内容分析为指导，使用 CDC 评估框架进行记录、转录和主题分析。
REACH 以低门槛模式提供丁丙诺啡、初级保健和心理健康服务。我们确定了与丁丙诺啡治疗提供相关的三个主题。首先，提供公平和低污名化医疗保健的组织使命，这是组织身份的关键。其次，一种低门槛的丁丙诺啡治疗方法至关重要，但引起了对过度处方的担忧，并带来了后勤方面的挑战。第三，通过提供基于价值的工作和消除提供者在提供丁丙诺啡治疗方面可能面临的行政障碍，创建和保留以减少伤害为导向的劳动力。
减少伤害的初级保健模式可以帮助减少吸毒者的污名化，并参与丁丙诺啡治疗。需要进一步研究评估这种模式是否能改善患者的治疗效果，能否克服社区利益相关者的担忧，以及是否具有可持续性。
