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J Subst Abuse Treat. 2019 Feb;97:28-40. doi: 10.1016/j.jsat.2018.11.007. Epub 2018 Nov 20.

"No more falling through the cracks": A qualitative study to inform measurement of integration of care of HIV and opioid use disorder.

Author information

1
National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, United States of America; Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America; Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States of America. Electronic address: benjamin.oldfield@yale.edu.
2
Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America.
3
AIDS Project New Haven, New Haven, CT, United States of America.
4
Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States of America.
5
Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, United States of America.

Abstract

INTRODUCTION:

Integration of HIV- and opioid use disorder (OUD)-related care is associated with improved patient outcomes. Our goal was to develop a novel instrument for measuring quality of integration of HIV and OUD-related care that would be applicable across diverse care settings.

METHODS:

Grounded in community-based participatory research principles, we conducted a qualitative study from August through November 2017 to inform modification of the Behavioral Health Integration in Medical Care (BHIMC) instrument, a validated measure of quality of integration of behavioral health in primary care. We conducted semi-structured interviews of patients (n = 22), focus groups with clinical staff (n = 24), and semi-structured interviews of clinic leadership (n = 5) in two urban centers in Connecticut.

RESULTS:

We identified three themes that characterize optimal integration of HIV- and OUD-related care: (1) importance of mitigating mismatches in resources and knowledge, particularly resources to address social risks and knowledge gaps about evidence-based treatments for OUD; (2) need for patient-centered policies and inter-organization communication, and (3) importance of meeting people where they are, geographically and at their stage of change. These themes highlighted aspects of integrated care for HIV and OUD not captured in the original BHIMC.

CONCLUSIONS:

Patients, clinical staff, and organization leadership perceive that addressing social risks, communication across agencies, and meeting patients in their psychosocial and structural context are important for optimizing integration of HIV and OUD-related care. Our proposed, novel instrument is a step towards measuring and improving service delivery locally and nationally for this vulnerable population.

KEYWORDS:

Community-based participatory research; HIV; Integrated delivery system; Opioid-related disorders; Qualitative research

PMID:
30577897
DOI:
10.1016/j.jsat.2018.11.007

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