Department of Public Health Policy and Management, School of Global Public Health, New York University, Broadway, NY, USA.
Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA.
Am J Drug Alcohol Abuse. 2023 Mar 4;49(2):206-215. doi: 10.1080/00952990.2023.2169832. Epub 2023 Mar 6.
Hospitals are well-positioned to integrate harm reduction into their workflow. However, the extent to which hospitals across the United States are adopting these strategies remains unknown. To assess what factors are associated with hospital adoption of harm reduction/risk education strategies, and trends of adoption across time. We constructed a dataset marking implementation of harm reduction/risk education strategies for a 20% random sample of nonprofit hospitals in the U.S ( = 489) using 2019-2021 community health needs assessments (CHNAs) and implementation strategies obtained from hospital websites. We used two-level mixed effects logistic regression to test the association between adoption of these activities and organizational and community-level variables. We also compared the proportion of hospitals that adopted these strategies in the 2019-2021 CHNAs to an earlier cohort (2015-2018.) In the 2019-2021 CHNAs, 44.7% ( = 219) of hospitals implemented harm reduction/risk education programs, compared with 34.1% ( = 156) in the 2015-2018 cycle. In our multivariate model, hospitals that implemented harm reduction/risk education programs had higher odds of having adopted three or more additional substance use disorder (SUD) programs (OR: 10.5: 95% CI: 5.35-20.62), writing the CHNA with a community organization (OR: 2.14; 95% CI: 1.15-3.97), and prioritizing SUD as a top three need in the CHNA (OR: 2.63; 95% CI: 1.54-4.47.) Our results suggest that hospitals with an existing SUD infrastructure and with connections to community are more likely to implement harm reduction/risk education programs. Policymakers should consider these findings when developing strategies to encourage hospital implementation of harm reduction activities.
医院非常适合将减少伤害纳入其工作流程。然而，美国各地的医院采用这些策略的程度尚不清楚。为了评估哪些因素与医院采用减少伤害/风险教育策略相关，以及随着时间的推移采用这些策略的趋势。我们使用 2019-2021 年社区卫生需求评估（CHNAs）和从医院网站获得的实施策略，为美国非营利性医院的 20%随机样本（= 489）构建了一个标记减少伤害/风险教育策略实施情况的数据集。我们使用两级混合效应逻辑回归来测试采用这些活动与组织和社区层面变量之间的关联。我们还比较了 2019-2021 年 CHNAs 中采用这些策略的医院比例与早期队列（2015-2018 年）的比例。在 2019-2021 年的 CHNAs 中，44.7%（= 219）的医院实施了减少伤害/风险教育计划，而在 2015-2018 年的周期中，这一比例为 34.1%（= 156）。在我们的多变量模型中，实施减少伤害/风险教育计划的医院采用三个或更多额外药物使用障碍（SUD）计划的可能性更高（OR：10.5：95% CI：5.35-20.62），与社区组织一起撰写 CHNA（OR：2.14；95% CI：1.15-3.97），并将 SUD 作为 CHNA 中的前三大需求之一（OR：2.63；95% CI：1.54-4.47）。我们的结果表明，具有现有 SUD 基础设施并与社区有联系的医院更有可能实施减少伤害/风险教育计划。政策制定者在制定鼓励医院实施减少伤害活动的策略时应考虑这些发现。
