Centre for Behaviour Change, University College London, London, WC1E 7HB, UK; National Institute for Health Research (NIHR) Health Protection Research Unit in Behavioural Science and Evaluation, Bristol, BS8 2BN, UK.
National Institute for Health Research (NIHR) Health Protection Research Unit in Behavioural Science and Evaluation, Bristol, BS8 2BN, UK; Population Health Sciences, University of Bristol, BS8 1QU, UK; NIHR Applied Research Collaboration West (ARC West), Bristol, BS1 2NT, UK.
Int J Drug Policy. 2022 Jan;99:103437. doi: 10.1016/j.drugpo.2021.103437. Epub 2021 Sep 29.
People who inject drugs may experience difficulty accessing or maintaining involvement with traditional healthcare services. This is associated with increased health inequalities and bio-psychosocial difficulties. Embedding physical healthcare services within community-based drug services may provide a practical and feasible approach to increase access and delivery of healthcare. This study explored the acceptability of, and barriers and facilitators to, embedding a pilot physical healthcare service within a community-based drug service in the United Kingdom (Bristol, England).
Semi-structured interviews were conducted with service users (people who inject drugs) (n = 13), and a focus group was conducted with service providers (n = 11: nine harm reduction workers, two nurses, one service manager). Topic guides included questions to explore barriers and facilitators to using and delivering the service (based on the COM-B Model), and acceptability of the service (using the Theoretical Framework of Acceptability). Transcripts were analysed using a combined deductive framework and inductive thematic analysis approach.
The service was viewed as highly acceptable. Service users and providers were confident they could access and provide the service respectively, and perceived it to be effective. Barriers included competing priorities of service users (e.g. drug use) and the wider service (e.g. equipment), and the potential impact of the service being removed in future was viewed as a barrier to overall healthcare access. Both service users and providers viewed embedding the physical health service within an existing community-based drug service as facilitating accessible and holistic care which reduced stigma and discrimination.
The current study demonstrated embedding a physical health service within an existing community-drug based and alcohol service was acceptable and beneficial. Future studies are required to demonstrate cost-effectiveness and ensure long-term sustainability, and to determine transferability of findings to other settings, organisations and countries.
注射毒品的人可能会在获得或维持传统医疗服务方面遇到困难。这与健康不平等加剧以及生物心理社会困难有关。在社区毒品服务中嵌入身体保健服务可能是增加医疗服务获取和提供的一种实用且可行的方法。本研究探讨了在英国（英格兰布里斯托尔）将试点身体保健服务嵌入社区毒品服务的可接受性，以及其中存在的障碍和促进因素。
对 13 名服务使用者（注射毒品者）进行了半结构式访谈，并对 11 名服务提供者（9 名减少伤害工作者、2 名护士、1 名服务经理）进行了焦点小组讨论。主题指南包括基于 COM-B 模型的使用和提供服务的障碍和促进因素，以及服务的可接受性（使用可接受性的理论框架）问题。使用综合演绎框架和归纳主题分析方法分析转录本。
该服务被认为是高度可接受的。服务使用者和提供者都有信心分别获得和提供服务，并认为该服务是有效的。障碍包括服务使用者（例如吸毒）和更广泛服务（例如设备）的优先事项竞争，以及该服务在未来被移除被视为整体医疗服务获取的障碍。服务使用者和提供者都认为将身体保健服务嵌入现有的社区毒品服务中有助于提供便捷和全面的护理，从而减少耻辱感和歧视。
本研究表明，将身体保健服务嵌入现有的社区毒品服务中是可以接受的，也是有益的。需要进一步的研究来证明成本效益，并确保长期可持续性，并确定研究结果在其他环境、组织和国家的可转移性。
