Engagement with physicians to enhance cultural safety in primary care for people who use substances: Final report

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Abstract
This report describes the development of best practice guidelines for primary care physicians working with people who use, or have used, substances. These patients often lack trust in, and access to primary care, and while some may be further marginalized and stigmatized through segregation in safer spaces associated with substance use (MacNeil & Pauly, 2011), others may opt out of discussing substance use with their doctor (Hartney et al, 2003). As primary care physicians are the gatekeepers of access to specialized services, it is imperative that cultural safety addresses discrimination faced by people who use substances in obtaining referrals to necessary specialized services. The purpose of the project was to develop a plan of action to improve cultural safety for people who use substances who are seeking primary care services. There were three aims to the action plan: first, to improve cultural safety in primary care; second, to co-create mutually agreed upon best practice guidelines for primary care physicians to provide care to this population of patients; and third, to develop an implementation plan. The objectives of the project were to develop collaborative relationships with people with lived experience of substance use, physicians, researchers and research users to enhance knowledge and further research in substance use treatment, cultural safety in primary care, and access to appropriate healthcare for people who use substances; to engage with physicians on their key concerns pertaining to lived experiences of primary care among people who use substances; to increase awareness and knowledge in understanding substance use specific cultural safety; to use findings from our research with people who use substances as the basis of knowledge for workshop discussions, and to validate the study recommendations; to develop a mutually agreed plan of action to collaboratively address improving primary care and promoting access to culturally safe healthcare for people who use substances, within and through primary care settings; to build capacity within primary care by mentoring research trainees with academic and community experts. Our recent research with people who use(d) substances has provided an understanding of what is needed for people who use substances to feel safe using primary care services (Urbanoski et al, 2018; Pauly et al, in press). The findings of this research was used as the basis for developing key questions for discussion in order to develop best practices in four key areas: primary care environment and management; interpersonal skills; medication and prescribing, and holistic healthcare. We held three days of workshops: an initial workshop to provide Peer Research Associates, who were patients who were trained to lead the workshops, to develop cultural safety within the workshop; a dialogue day with Peer Research Associates, researchers, physicians, and health systems partners, which used a world café to develop best practices; and a follow up day with Peer Research Associates, researchers, physicians, and health systems partners to validate the resources that were developed. We developed three key resources to disseminate the best practices: a one page summary of actions that can be taken to improve supportive primary care for people who use substances; a checklist for primary care practices; and a website compiling the best practice resources for download, providing background information on the project, and providing links to community resources. This website is available at www.SuportingPatientsWhoUse.net. The implementation plan comprised the development of the resources, dissemination through the website and through presentations, and distributing online and printed resources through the Victoria Division of Family Practice, and the Patients as Partners team within the Ministry of Health, and by embedding the resources on Pathways, an online resource for physicians. Future development of the guidelines will focus on explicitly addressing cultural safety in Indigenous patients who use substances. Additional research is needed to better understand and address trauma-informed care and transdisciplinary primary care. Further collaboration is also needed with physician, nurse practitioner, and medical office assistant training programs and organizations who may provide related services and supports, such as Pain BC. These additional collaborations are beyond the scope of this project, and will require further funding.
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© 2019 Elizabeth Hartney
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