Literature Collection

Integration of health and social care is increasingly central to improving outcomes, experience and sustainability; however, integrated care is not a single construct. This article presents a novel framework to categorize and conceptualize different approaches to integrated care, illustrating variations in attributes, context, complexity and impact. Drawing on international literature, three approaches to integration - condition-based, multi-condition and population-based - are examined along a continuum. Condition-based approaches focus on defined patient groups using standardized clinical pathways requiring limited coordination. Multi-condition integration supports populations with complex chronic conditions, requiring comprehensive, multi-sectoral coordination and interconnected structures. Population-based integration represents the broadest approach, organizing health and social care around community needs and social determinants of health and necessitating system-level governance with aligned policy and funding. While integrated care models can advance without explicitly delivering population health outcomes, population health cannot be advanced without integration as a foundational enabler.

BACKGROUND: Stigma is a barrier to the uptake of buprenorphine to treat opioid use disorder. Harm reduction treatment models intend to minimize this stigma by organizing care around non-judgmental interactions with people who use drugs. There are few examples of implementing buprenorphine treatment using a harm reduction approach in a primary care setting in the USA. METHODS: We conducted a qualitative study by interviewing leadership, staff, and external stakeholders at Respectful, Equitable Access to Compassionate Healthcare (REACH) Medical in Ithaca, NY. REACH is a freestanding medical practice that provides buprenorphine treatment for opioid use disorder since 2018. We conducted semi-structured interviews with 17 participants with the objective of describing REACH's model of care. We selected participants based on their position at REACH or in the community. Interviews were recorded, transcribed, and analyzed for themes using content analysis, guided by the CDC Evaluation Framework. RESULTS: REACH provided buprenorphine, primary care, and mental health services in a low-threshold model. We identified three themes related to delivery of buprenorphine treatment. First, an organizational mission to provide equitable and low-stigma healthcare, which was a key to organizational identity. Second, a low-threshold buprenorphine treatment approach that was critical, but caused concern about over-prescribing and presented logistical challenges. Third, creation and retention of a harm reduction-oriented workforce by offering value-based work and by removing administrative barriers providers may face elsewhere to providing buprenorphine treatment. CONCLUSIONS: A harm reduction primary care model can help reduce stigma for people who use drugs and engage in buprenorphine treatment. Further research is needed to evaluate whether this model leads to improved patient outcomes, can overcome community stakeholder concerns, and is sustainable.