Integration of a community-based harm reduction program into a safety net hospital: a qualitative study

Area of Science:

• Public Health
• Addiction Medicine
• Qualitative Research

Background:

• Community-based harm reduction programs are vital for reducing drug use-related harm.
• Hospital addiction services often focus on acute issues, with limited integration of community harm reduction.
• This study explores provider views on implementing harm reduction in hospitals.

Purpose of the Study:

• To describe provider perspectives on implementing a harm reduction in-reach program in a hospital setting.
• To identify facilitators and barriers to integrating community-based harm reduction into inpatient care.
• To gather recommendations for improving hospital-based harm reduction initiatives.

Main Methods:

• Conducted 24 semi-structured interviews with hospital providers in 2021.
• Utilized inductive thematic analysis based on grounded theory principles.
• Focused on providers from harm reduction, addiction consult, and observation units.

Main Results:

• Thematic analysis identified seven major themes regarding implementation.
• Key facilitators and barriers included medical hierarchy power dynamics, addiction stigma, and care team coordination.
• Streamlined referral processes and clear role delineation were highlighted as beneficial.

Conclusions:

• Integrating community harm reduction into hospitals bridges inpatient and outpatient care.
• This approach expands access to patient-centered, low-barrier harm reduction services.
• Addressing provider perspectives is crucial for successful program implementation.