Barriers and facilitators to primary care engagement for people who inject drugs: A systematic review.
Omeid Heidari, Kayla Tormohlen, Derek T Dangerfield and 3 others
PMID 36480158WHAT IT FOUND
Having health insurance, stable housing, and a trusting relationship with a provider strongly predicted primary care engagement for people who inject drugs.
Active injection use, homelessness, and stigma were major barriers. Co-locating services helped, but evidence quality varied.
Key findings
01Health insurance was significantly associated with increased primary care visits and ART uptake across all five studies that examined it.
02Positive patient-provider relationships were associated with greater engagement, while lack of rapport was associated with poorer outcomes.
03Active injection drug use was consistently identified as a barrier to healthcare engagement across nine studies.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review excluded qualitative studies, limiting the depth of understanding regarding patient experiences. Most included studies were observational, restricting causal inferences. Definitions of 'engagement' varied widely across studies, making synthesis difficult. Many studies did not adequately stratify results by race, ethnicity, or gender, and samples were often predominantly male. The review was limited to US-based studies, which may not generalize to other healthcare systems.
Declared interests
The authors report no real or perceived vested interests related to this article that could be construed as a conflict of interest.
The easy way to misread this
Do not assume that co-locating services definitively improves outcomes based on this review; the evidence for this was descriptive and rated lower quality. The strong associations with insurance and housing reflect observational data, so improving these factors may not automatically cause better engagement without addressing underlying barriers like stigma.