• Katherine Dunham, Catherine Rivas, Paula Medina Blanco, Betty Kolod, Carli Salvati, Katie Clark, Kimberly L Sue, Ashley Hagaman, and Jeffrey J Weiss.
• Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA. katherine.dunham@yale.edu.
• J Gen Intern Med. 2024 Jul 1; 39 (9): 168116891681-1689.

BackgroundPrimary care is an important yet underutilized resource in addressing the overdose crisis. Previous studies have identified important aspects of primary care for people who use drugs (PWUD) and have found patient involvement in healthcare decisions and goal-setting to be especially critical. However, there has been limited research describing the primary care goals of PWUD. In harm reduction settings, where it is imperative that PWUD set their own goals, this research gap becomes especially relevant.ObjectiveTo explore how PWUD navigate primary care with a focus on understanding their primary care goals.DesignA qualitative study using semi-structured interviews.ParticipantsPWUD currently engaged in primary care at the Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, a harm reduction-based primary care program in New York City.ApproachBetween June 2022 and August 2022, we conducted 17 semi-structured interviews. Informed by phenomenology, transcripts were coded using both inductive and deductive codes and themes were developed using thematic analysis approaches.Key ResultsPhenomenological analysis identified four core components that, together, created an experience that participants described as "a partnership" between patient and provider: (1) patient-provider collaboration around patient-defined healthcare goals; (2) support provided by harm reduction-based approaches to primary care anchored in incrementalism and flexibility; (3) care teams' ability to address healthcare system fragmentation; and (4) the creation of social connections through primary care. This holistic partnership fostered positive primary care experiences and supported participants' self-defined care goals, thereby facilitating meaningful care outcomes.ConclusionsTo best meet the primary care goals of PWUD, these findings underscore the importance of primary care providers and programs facilitating such partnerships through organizational-level support anchored in harm reduction. Future research should explore how these experiences in primary care affect patient health outcomes, ultimately shaping best practices in the provision of high-quality primary care for PWUD.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

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