Social Science
A Scoping Review of Barriers and Facilitators to the Integration of Substance Use Treatment Services into US Mainstream Health Care
Esther Adeniran,
Esther Adeniran
Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
Megan Quinn,
Megan Quinn
Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States
Richard Wallace,
Richard Wallace
Quillen College of Medicine Library, East Tennessee State University, Johnson City, TN 37614, United States
Rachel R. Walden,
Rachel R. Walden
Quillen College of Medicine Library, East Tennessee State University, Johnson City, TN 37614, United States
Titilola Labisi,
Titilola Labisi
Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, United States
Afolakemi Olaniyan,
Afolakemi Olaniyan
Department of Health Promotion and Education, School of Human Sciences, University of Cincinnati, Cincinnati, OH 45221, United States
Robert Pack,
Robert Pack
Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States
Billy Brooks
Billy Brooks
Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States
Peer Reviewed
Abstract
Background Following the national implementation of the Affordable Care Act (ACA) in 2014, barriers still exist that limit the adoption of substance use treatment (SUT) services in mainstream health care (MHC) settings in the United States. This study provides an overview of current evidence on barriers and facilitators to integrating various SUT services into MHC. Methods A systematic search was conducted with the following databases: “PubMed including MEDLINE”, “CINAHL”, “Web of Science”, “ABI/Inform”, and “PsycINFO.” We identified barriers and/or facilitators affecting patients, providers, and programs/systems. Results Of the 540 identified citations, 36 were included. Main barriers were identified for patients (socio-demographics, finances, confidentiality, legal impact, and disinterest), providers (limited training, lack of time, patient satisfaction concerns, legal implications, lack of access to resources or evidence-based information, and lack of legal/regulatory clarity), and programs/systems (lack of leadership support, lack of staff, limited financial resources, lack of referral networks, lack of space, and lack of state-level support). Also, we recognized key facilitators pertaining to patients (trust for providers, education, and shared decision making), providers (expert supervision, use of support team, training with programs like Extension for Community Health Outcomes (ECHO), and receptivity), and programs/systems (leadership support, collaboration with external agencies, and policies e.g., those expanding the addiction workforce, improving insurance access and treatment access). Conclusions This study identified several factors influencing the integration of SUT services in MHC. Strategies for improving SUT integration in MHC should address barriers and leverage facilitators related to patients, providers, and programs/systems.
Key Questions
What are the main barriers preventing patients from accessing integrated SUT services?
Patients face several obstacles, including socio-demographic factors, financial constraints, concerns about confidentiality, potential legal repercussions, and a general disinterest or lack of awareness regarding available treatments.
What challenges do healthcare providers encounter in delivering SUT services within mainstream settings?
Providers often grapple with limited training in substance use disorders, time constraints, concerns about patient satisfaction, potential legal implications, lack of access to resources or evidence-based information, and ambiguity in legal or regulatory guidelines.
What systemic issues hinder the integration of SUT services into mainstream healthcare?
At the program or system level, barriers include insufficient leadership support, staffing shortages, limited financial resources, lack of referral networks, inadequate physical space, and insufficient support at the state level.
What factors facilitate the successful integration of SUT services into mainstream healthcare?
Facilitators include building patient trust in providers, patient education, shared decision-making, expert supervision for providers, utilization of support teams, training programs like Extension for Community Health Outcomes (ECHO), provider receptivity, leadership support within organizations, collaboration with external agencies, and policies aimed at expanding the addiction workforce and improving access to insurance and treatment.
What strategies can enhance the integration of SUT services into mainstream healthcare?
To improve integration, strategies should address identified barriers and leverage facilitators across patient, provider, and system levels. This includes enhancing provider training, increasing financial and leadership support, developing robust referral networks, and implementing supportive policies at both organizational and state levels.
