• Zoe Lindenfeld, Holly Hagan, and Ji Eun Chang.
• Department of Public Health Policy and Management, School of Global Public Health, New York University, 726 Broadway, New York, NY, 10012, USA. zll213@nyu.edu.
• J Gen Intern Med. 2023 Nov 1; 38 (15): 327332823273-3282.

BackgroundEvidence suggests that harm reduction, a public health strategy aimed at reducing the negative consequences of a risky health behavior without requiring elimination of the behavior itself, may be a promising approach for minimizing drug-related harms while engaging individuals with substance use disorders (SUDs) in care. However, philosophical clashes between the medical and harm reduction models may pose barriers to adopting harm reduction approaches within medical settings.ObjectiveTo identify barriers and facilitators to implementing a harm reduction approach toward care within healthcare settings. We conducted semi-structured interviews with providers and staff at three integrated harm reduction and medical care sites in New York.DesignQualitative study using in-depth and semi-structured interviews.ParticipantsTwenty staff and providers across three integrated harm reduction and medical care sites across New York state.ApproachInterview questions focused on how harm reduction approaches were implemented and demonstrated in practice and barriers and facilitators to implementation, as well as questions based on the five domains of the Consolidated Framework for Implementation Research (CFIR).Key ResultsWe identified three key barriers to the adoption of the harm reduction approach that surrounded resource constraints, provider burnout, and interacting with external providers that do not have a harm reduction orientation. We also identified three facilitators to implementation, which included ongoing training both within and external to the clinic, team-based and interdisciplinary care, and affiliations with a larger healthcare system.ConclusionsThis study demonstrated that while multiple barriers to implementing harm reduction informed medical care existed, health system leaders can adopt practices to mitigate barriers to adoption, such as value-based reimbursement models and holistic models of care that address the full spectrum of patient needs.© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.

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