Facilitators and barriers to integrating physical health care during treatment for substance use: A socio‐ecological analysis

Abstract

Introduction and Aims Clinical practice guidelines recommend physical health be addressed when treating substance use disorders. Yet, the integration of alcohol and other drug (AOD) treatment and physical health care is seldom actualised. This is particularly the case in the non‐government sector. Using the socio‐ecological model as a framework, this study aimed to examine the facilitators and barriers to integrating physical health in non‐government AOD services. Design and Methods Interviews were conducted with residential and outpatient AOD services across New South Wales, Australia. Qualitative data were collected from service users (n = 20) and clinicians (n = 13). Interview data were transcribed then systematically coded and analysed using iterative categorisation. Results Most staff recognised physical health care as a fundamental component of treatment for substance use even when there were personal, professional and structural barriers for doing so. Service users reported a diverse range of health and social benefits when physical health care was incorporated in to AOD treatment. An exception to this was some negative experiences with health‐care providers that were not identified by staff. Discussion and Conclusions Findings highlight the importance of developing resources to enhance the health literacy and capacity of non‐government AOD services to address the physical health of clients. Given some clients reported negative experiences with health‐care providers that were not identified by staff, services should seek regular feedback from clients regarding their experiences with external providers. The effectiveness of existing and new physical health initiatives within non‐government organisation AOD services needs more formal evaluation.

Systematic review of guidelines for managing physical health during treatment for substance use disorders: Implications for the alcohol and other drug workforce

“…These tools are then included as appendices in this guideline for ease of access and use. Access to funding and resources across AOD treatment services is not equal [37] and will limit the extent to which research findings and guideline recommendations can be applied by individual service providers [39]. Efforts to improve guideline applicability, particularly for AOD treatment services that face funding and resource constraints may encourage these services to implement recommendations related to the management of client physical health.…”

“…Efforts to specify how the AOD workforce (particularly those without medical training) can use recommendations such as these is needed. Since gaps in professional knowledge of AOD workers has been cited as a barrier for assessing and managing client physical health [27,37,39,90], staff training related to diagnostic testing and biomarkers may also be useful.…”

“…Investment in inter-agency partnerships with external primary healthcare providers is another economical option for improved coordination of care. Inter-agency partnerships can establish more seamless referral pathways, linking those in treatment for substance use to appropriate health-care providers in the community [39], including services such as acute hospital care, comprehensive primary care, dental care and specialist services such as hepatology clinics. Guideline development groups should also consider the advantages of including localised guides for referral pathways as was done by some of the guidelines in this review.…”

“…Literature has reported on some of the structural and organisational factors that can undermine efforts of AOD treatment services and the AOD workforce when addressing physical health comorbidities of those in treatment [37][38][39]. One factor identified as contributing to suboptimal management of physical health comorbidities is the way that AOD services are often disconnected from primary health-care providers [40].…”

“…This disconnect can cause fragmented service provision, impeding access to necessary health care for people who are attending AOD treatment and hampering efforts to engage primary health-care practitioners in the treatment of substance use disorders [37]. Service fragmentation can mean that even when physical health needs are identified during AOD treatment, referral pathways from AOD treatment services to primary health care may not be established [19,39].…”