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01-01-2021 | Opioids | Original Research

“Health Is on the Back Burner:” Multilevel Barriers and Facilitators to Primary Care Among People Who Inject Drugs

Authors: Delia Motavalli, BS, Jessica L. Taylor, MD, Ellen Childs, PhD, MA, Pablo K. Valente, MD, MPH, Peter Salhaney, ScM, Jennifer Olson, MBA, Dea L. Biancarelli, MS, Alberto Edeza, BS, BA, Joel J. Earlywine, MS, Brandon D. L. Marshall, PhD, Mari-Lynn Drainoni, PhD, Med, Matthew J. Mimiaga, ScD, MPH, Katie B. Biello, PhD, MPH, Angela R. Bazzi, PhD, MPH

Published in: Journal of General Internal Medicine | Issue 1/2021

Abstract

Background

The estimated 2.2 million people who inject drugs (PWID) in the USA experience significant gaps in preventive healthcare and a high burden of infectious, psychiatric, and other chronic diseases. Many PWID rely on emergency medical services, which are costly and not designed to deliver preventive services, manage chronic conditions, or address social needs.

Objective

The objective of this study was to explore barriers and facilitators to primary care utilization from the perspectives of PWID in New England, a region highly affected by the overdose crisis.

Design

Participants completed semi-structured qualitative interviews exploring substance use and healthcare utilization patterns.

Participants

We recruited 78 PWID through community-based organizations (e.g., syringe service programs) in 16 urban and non-urban communities throughout Massachusetts and Rhode Island.

Approach

Thematic analysis identified barriers and facilitators to primary care utilization at the individual, interpersonal, and systemic levels.

Key Results

Among 78 PWID, 48 described recent primary care experiences; 33 had positive experiences and 15 described negative experiences involving discrimination or mistrust. Individual-level barriers to primary care utilization included perceived lack of need and competing priorities (e.g., avoiding opioid withdrawal, securing shelter beds). Interpersonal-level barriers included stigma and perceived low quality of care for PWID. Systemic-level barriers included difficulty navigating healthcare systems, inadequate transportation, long wait times, and frequent provider turnover. Participants with positive primary care experiences explained how appointment reminders, flexible hours, addiction medicine–trained providers, case management services, and transportation support facilitated primary care utilization and satisfaction.

Conclusions

Findings regarding the multilevel barriers and facilitators to accessing primary care among PWID identify potential targets for programmatic interventions to improve primary care utilization in this population. Based on these findings, we make recommendations for improving the engagement of PWID in primary care as a means to advance individual and public health outcomes.

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Title: “Health Is on the Back Burner:” Multilevel Barriers and Facilitators to Primary Care Among People Who Inject Drugs
Authors: Delia Motavalli, BS
Jessica L. Taylor, MD
Ellen Childs, PhD, MA
Pablo K. Valente, MD, MPH
Peter Salhaney, ScM
Jennifer Olson, MBA
Dea L. Biancarelli, MS
Alberto Edeza, BS, BA
Joel J. Earlywine, MS
Brandon D. L. Marshall, PhD
Mari-Lynn Drainoni, PhD, Med
Matthew J. Mimiaga, ScD, MPH
Katie B. Biello, PhD, MPH
Angela R. Bazzi, PhD, MPH
Publication date: 01-01-2021
Publisher: Springer International Publishing
Keywords: Opioids
Opioids
Care
Published in: Journal of General Internal Medicine / Issue 1/2021
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-020-06201-6

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