Date of Award

1-1-2023

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Ashley Hagaman

Abstract

Background: Primary care is an important yet underutilized resource in addressing the overdose crisis. Previous studies that have explored people who use drugs’ (PWUD) experiences in primary care have found patient involvement in care decisions and goal-setting to be especially important. However, there has been limited research describing PWUD’s goals specific to primary care. This study utilized qualitative methods to explore how PWUD navigate primary care with a focus on understanding participants’ primary care goals.

Methods: From June — August 2022, we conducted 17 semi-structured interviews with PWUD currently in care at The REACH Program, a harm reduction-based primary care program in New York City. Informed by phenomenology, transcripts were coded using both inductive and deductive codes and themes were developed in line with thematic analysis approaches.

Results: Based on participants’ narratives, we identified four major themes: collaboration between patient and provider around patient-defined care goals, support provided by harm reduction-based approaches to primary care rooted in incrementalism and flexibility, care teams’ ability to address fragmentation in the healthcare system, and the creation of social connection through primary care. Ultimately, through these four components, providers were able to create what participants described as “a partnership” which, in turn, fostered positive primary care experiences and supported patients’ self-defined care goals.

Conclusions: Given these findings, it’s critical that primary care providers and programs facilitate such partnerships through organization-level programs and support. Future research should explore how these experiences in primary care affect patient health outcomes, ultimately informing the provision of high quality primary care for PWUD.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 05/10/2025

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