Access to healthcare insurance and healthcare services among syringe exchange program clients in Massachusetts: qualitative findings from health navigators with the iDU ("I do") Care Collaborative
Access to healthcare insurance and healthcare services among syringe exchange program clients in Massachusetts: qualitative findings from health navigators with the iDU ("I do") Care Collaborative
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DOI：
10.1186/s12954-017-0151-4
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发表时间：
2017-05-18
影响因子：
4.4
通讯作者：
Donahue, Ashley
中科院分区：
文献类型：
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作者：
Stopka, Thomas J.;Hutcheson, Marguerite;Donahue, Ashley
背景：参与注射器交换计划（sep）的注射吸毒者（PWID）获得医疗保险的情况鲜为人知。本研究的目的是评估SEP员工（包括健康导航员和项目经理）在实施州和联邦政策以加强马萨诸塞州全民医疗保健获取之后，对SEP客户获得健康保险和医疗保健获取的看法。方法：2014年12月至2015年1月，我们对SEP工作人员（包括项目经理和健康导航员）进行了深度访谈（n = 14），以评估SEP客户对健康保险登记和获得强化转诊的知识、态度和信念。我们根据访谈指南制定了一个初步的编码方案，并使用基于理论的方法来指导从数据中产生的后续主题代码的包含。我们使用基于共识的方法，以迭代的方式对编码数据进行主题分析。结果：我们确定了定性访谈中出现的五个主要主题，包括SEP客户中高水平的健康保险注册；参加医疗保险的障碍；急需的转诊服务，包括改善获得药物使用障碍治疗和丙型肝炎病毒治疗的机会；向客户推荐这些急需服务的障碍；以及对政策变化的建议。结论：虽然登记障碍和迫切需要的转诊仍然存在，但马萨诸塞州sep的PWID获得和登记医疗保险计划的机会很高。2016年美国总统大选后，《平价医疗法案》（Affordable Care Act）的稳定性不确定，我们的研究结果总结了马萨诸塞州与医疗保险和医疗服务获取相关的机遇和挑战。在促进获得医疗保险和加强获得预防性保健和初级保健方面，残疾人保健计划可发挥重要作用。
Background: Little is known about access to health insurance among people who inject drugs (PWID) who attend syringe exchange programs (SEPs). The goal of the current study was to assess perceptions of SEP staff, including health navigators and program managers, on access to health insurance and healthcare access among SEP clients following implementation of state and federal policies to enhance universal healthcare access in Massachusetts.Methods: Between December 2014 and January 2015, we conducted in-depth interviews (n = 14) with SEP staff, including both program managers and health navigators, to assess knowledge, attitudes, and beliefs related to health insurance enrollment and access to enhanced referrals among SEP clients. We developed a preliminary coding scheme from the interview guide and used a grounded theory approach to guide inclusion of subsequent thematic codes that emanated from the data. We analyzed the coded data thematically in an iterative fashion using a consensus-based approach.Results: We identified five primary themes that emerged from the qualitative interviews, including high levels of health insurance enrollment among SEP clients; barriers to enrolling in health insurance; highly needed referrals to services, including improved access to substance use disorder treatment and hepatitis C virus treatment; barriers to referring clients to these highly needed services; and recommendations for policy change.Conclusions: While barriers to enrollment and highly needed referrals remain, access to and enrollment in healthcare insurance plans among PWID at SEPs in Massachusetts are high. With the uncertain stability of the Affordable Care Act following the US presidential election of 2016, our findings summarize the opportunities and challenges that are connected to health insurance and healthcare access in Massachusetts. SEPs can play an important role in facilitating access to health insurance and enhancing access to preventive health and primary care.