Department of Public Health Policy and Management, School of Global Public Health, New York University, 726 Broadway, New York, NY, 10012, USA.
Department of Social and Behavioral Sciences, School of Global Public Health, New York University, 726 Broadway, New York, NY, 10012, USA.
J Gen Intern Med. 2023 Nov;38(15):3273-3282. doi: 10.1007/s11606-023-08231-2. Epub 2023 May 25.
Evidence suggests that harm reduction, a public health strategy aimed at reducing the negative consequences of a risky health behavior without requiring elimination of the behavior itself, may be a promising approach for minimizing drug-related harms while engaging individuals with substance use disorders (SUDs) in care. However, philosophical clashes between the medical and harm reduction models may pose barriers to adopting harm reduction approaches within medical settings.
To identify barriers and facilitators to implementing a harm reduction approach toward care within healthcare settings. We conducted semi-structured interviews with providers and staff at three integrated harm reduction and medical care sites in New York.
Qualitative study using in-depth and semi-structured interviews.
Twenty staff and providers across three integrated harm reduction and medical care sites across New York state.
Interview questions focused on how harm reduction approaches were implemented and demonstrated in practice and barriers and facilitators to implementation, as well as questions based on the five domains of the Consolidated Framework for Implementation Research (CFIR).
We identified three key barriers to the adoption of the harm reduction approach that surrounded resource constraints, provider burnout, and interacting with external providers that do not have a harm reduction orientation. We also identified three facilitators to implementation, which included ongoing training both within and external to the clinic, team-based and interdisciplinary care, and affiliations with a larger healthcare system.
This study demonstrated that while multiple barriers to implementing harm reduction informed medical care existed, health system leaders can adopt practices to mitigate barriers to adoption, such as value-based reimbursement models and holistic models of care that address the full spectrum of patient needs.
有证据表明，减少伤害是一种公共卫生策略，旨在减少危险健康行为的负面后果，而无需消除行为本身，对于减少与药物相关的伤害并使药物使用障碍（SUD）患者参与治疗可能是一种很有前途的方法。然而，医学模式和减少伤害模式之间的哲学冲突可能会对在医疗环境中采用减少伤害方法造成障碍。
确定在医疗环境中实施减少伤害方法来提供护理的障碍和促进因素。我们对纽约州三个综合减少伤害和医疗保健场所的提供者和工作人员进行了半结构式访谈。
使用深入和半结构化访谈的定性研究。
纽约州三个综合减少伤害和医疗保健场所的 20 名工作人员和提供者。
访谈问题侧重于了解如何在实践中实施和展示减少伤害方法，以及实施的障碍和促进因素，以及基于实施研究综合框架（CFIR）的五个领域的问题。
我们确定了采用减少伤害方法的三个关键障碍，这些障碍围绕资源限制、提供者倦怠以及与没有减少伤害方向的外部提供者的互动。我们还确定了三个实施的促进因素，包括内部和外部诊所的持续培训、以团队为基础和跨学科的护理，以及与更大的医疗保健系统的联系。
本研究表明，尽管在实施减少伤害为基础的医疗护理方面存在多种障碍，但卫生系统领导者可以采取措施来减轻采用障碍，例如基于价值的报销模式和整体护理模式，以满足患者的全部需求。
