A scoping review of barriers and facilitators to the integration of substance use treatment services into US mainstream health care

Esther Adeniran; Megan Quinn; Richard Wallace; Rachel R Walden; Titilola Labisi; Afolakemi Olaniyan; Billy Brooks; Robert Pack

doi:10.1016/j.dadr.2023.100152

A scoping review of barriers and facilitators to the integration of substance use treatment services into US mainstream health care

Drug Alcohol Depend Rep. 2023 Mar 24:7:100152. doi: 10.1016/j.dadr.2023.100152. eCollection 2023 Jun.

Authors

Esther Adeniran^{1

2}, Megan Quinn², Richard Wallace³, Rachel R Walden³, Titilola Labisi⁴, Afolakemi Olaniyan⁵, Billy Brooks², Robert Pack⁶

Affiliations

¹ Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States.
² Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States.
³ Quillen College of Medicine Library, East Tennessee State University, Johnson City, TN 37614, United States.
⁴ Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, United States.
⁵ Department of Health Promotion and Education, School of Human Sciences, University of Cincinnati, Cincinnati, OH 45221, United States.
⁶ Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States.

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.

Keywords: Affordable Care Act; Barriers; facilitators; health care settings; integration; scoping review; substance use treatment.

Publication types

Review