Turi Eleanor, Aronowitz Shoshana V, Bettencourt Amanda, Li Allison, Lin Jessica, McFadden Rachel, Mandell David, Wolk Courtney Benjamin
University of Pennsylvania, Philadelphia, U.S..
University of Pennsylvania, Philadelphia, U.S.
Harm Reduct J. 2025 May 21;22(1):84. doi: 10.1186/s12954-025-01241-9.
People who use drugs (PWUD) have long required wound care-a need that has become more urgent with the rise of xylazine, an animal tranquilizer in the street opioid supply associated with necrotic wounds. When PWUD visit the hospital for wound care, they often face discrimination from healthcare staff and leave the hospital before treatment completion. Low barrier wound care, community-based wound care that is grounded in harm reduction, is promising for meeting PWUD where they are and providing trustworthy, high quality care. Yet, access to low barrier wound care remains limited. This study explored determinants of and strategies for scaling up low barrier wound care for PWUD.
We utilized a prospective sequential exploratory mixed methods design, including semi-structured 1:1 interviews, community advisory board (CAB) meetings, and an online survey. The study was conducted from April 2024-September 2024 in Philadelphia, Pennsylvania and surrounding regions. We included wound care providers, administrators, and recovery specialists of low barrier sites with walk-in, flexible services and harm reduction approaches. The interviews identified determinants of scaling up low barrier wound care, guided by the Consolidated Framework for Implementation Research. We then facilitated CAB meetings and conducted a survey of CAB members to identify community-generated implementation strategies and assess acceptability, feasibility, and appropriateness of CAB-generated strategies. We also generated evidence-based implementation strategies using the Expert Recommendations for Implementing Change compilation.
Participants identified many barriers, including stigma, social needs, local policies, unstable funding, lack of specialized knowledge, and unstandardized evidence. Promising implementation strategies include using mass media to address stigma, developing resource sharing agreements between sites, revising professional roles to spread knowledge, and building academic partnerships to develop evidence. The most acceptable, feasible, and appropriate strategy rated by the CAB was offering social needs services (e.g., food, showers) within low barrier wound care sites.
Many factors at different levels influence the availability and quality of low barrier wound care for PWUD. Our results suggest that communities would benefit from a local needs assessment to identify and tailor strategies for scaling up care. Future work will test the effectiveness and implementation of identified strategies.
长期以来，吸毒者一直需要伤口护理——随着赛拉嗪（一种与坏死性伤口相关的街头阿片类药物供应中的动物镇静剂）的出现，这一需求变得更加迫切。当吸毒者前往医院接受伤口护理时，他们常常面临医护人员的歧视，在治疗完成前就离开医院。低门槛伤口护理，即基于减少伤害的社区伤口护理，有望在吸毒者所在之处为他们提供服务，并提供值得信赖的高质量护理。然而，获得低门槛伤口护理的机会仍然有限。本研究探讨了扩大吸毒者低门槛伤口护理的决定因素和策略。
我们采用了前瞻性序列探索性混合方法设计，包括半结构化一对一访谈、社区咨询委员会（CAB）会议和在线调查。该研究于2024年4月至2024年9月在宾夕法尼亚州费城及周边地区进行。我们纳入了提供随到随诊、灵活服务和减少伤害方法的低门槛场所的伤口护理提供者、管理人员和康复专家。访谈确定了扩大低门槛伤口护理的决定因素，以实施研究综合框架为指导。然后，我们组织了CAB会议，并对CAB成员进行了调查，以确定社区产生的实施策略，并评估CAB产生的策略的可接受性、可行性和适宜性。我们还利用实施变革专家建议汇编生成了基于证据的实施策略。
参与者确定了许多障碍，包括耻辱感、社会需求、地方政策、资金不稳定、缺乏专业知识和证据不规范。有前景的实施策略包括利用大众媒体消除耻辱感、制定场所之间的资源共享协议、修订专业角色以传播知识，以及建立学术伙伴关系以发展证据。CAB评定的最可接受、可行和适宜的策略是在低门槛伤口护理场所提供社会需求服务（如食物、淋浴）。
不同层面的许多因素影响着吸毒者低门槛伤口护理的可及性和质量。我们的结果表明，社区将受益于当地需求评估，以确定和调整扩大护理的策略。未来的工作将测试已确定策略的有效性和实施情况。
