Barriers and facilitators to primary care engagement for people who inject drugs: A systematic review

• Published in: Journal of nursing scholarship 2023-05, Vol.55 (3), p.605-622
• Main Authors: Heidari, Omeid, Tormohlen, Kayla, Dangerfield, Derek T., Tobin, Karin E., Farley, Jason E, Aronowitz, Shoshana V.
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Addictive behaviors; advanced practice nursing; AIDS; Chronic Disease; Chronic illnesses; Clinical outcomes; Comorbidity; Delivery of Health Care; Diabetes; Disease control; Disease prevention; Drug abuse; Drug use; Drug Users; Health behavior; health disparities; Health services utilization; Health status; Hepatitis C; HIV Infections; HIV/AIDS; Holistic approach; Humans; Hypertension; Infectious diseases; Medical diagnosis; Mental health care; Morbidity; Narcotics; Nurses; Observational studies; Preventive medicine; Primary care; Primary Health Care; Sexually transmitted diseases; STD; Substance abuse; Substance abuse treatment; Substance Abuse, Intravenous - complications; Substance Abuse, Intravenous - epidemiology; substance use; Substance use disorder; Systematic review
• ISSN: 1527-6546; 1547-5069
• DOI: 10.1111/jnu.12863

Introduction People who inject drugs (PWID) have a greater burden of multimorbid chronic diseases than the general population. However, little attention has been paid to the engagement in primary care for services related specifically to injection drug use and management of underlying chronic comorbid diseases for this population. This systematic review identified facilitators and barriers to healthcare engagement in the primary care setting among PWID. Design and Methods Studies were identified by a literature search of PubMed, CINAHL, and EMBASE, and by searching the references of retrieved articles. Studies were included if they measured active injection drug use, and outcomes related to primary care engagement characterized by: diagnosis of a health condition, linkage or retention in care, health condition‐related outcomes, and reported patient–provider relationship. Results Twenty‐three articles were included. Using the behavioral model, factors within predisposing, enabling, need, and health behavior domains were identified. Having co‐located services and a positive patient–provider relationship were among the strongest factors associated with healthcare utilization and engagement while active injection drug use was associated with decreased engagement. Conclusions To our knowledge, this is the only review of evidence that has examined factors related to primary care engagement for people who inject drugs. Most articles were observational studies utilizing descriptive designs. Although the assessment of the evidence was primarily rated ‘Good’, this review identifies a significant need to improve our understanding of primary care engagement for PWID. Future research and intervention strategies should consider these findings to better integrate the holistic care needs of PWID into primary care to reduce morbidity and mortality associated with injection drug use and chronic disease. Clinical relevance Primary care engagement is important for preventative care, early diagnosis of disease, and management of chronic diseases, including addressing problems of substance use. This review highlights factors nurses can utilize to facilitate primary care engagement of PWID.