Be good for a group discussion. . . just because I think time wise I think during clinic, it would be very lengthy. They would all want to try it (the demonstration with equipment). (Physician) For any integration to occur at the physician level, a paradigm shift in role may need to occur, as well as additional time for visits. The challenges are really more of a time factor because you’re trying to do it during clinic hours when other patients are waiting to be seen. And it seems like the time flies when you’re in the room with a patient. I don’t know how people see patients in 10 min. (Physician) The time barrier also seemed to be commonly linked to the frustration with other pressing responsibilities, such as paperwork, which interfere with providing more extensive clinical care services. This may be of particular concern in a publicly-funded clinic, whose paperwork requirements and grant writing are often completed by clinical leadership, and require time away from patients to complete. Whether it’s a form to go to the dentist or whatever it is you need, we take care of it, so it isn’t the actual hands on with the patient. A lot of times, it’s the paperwork that takes you a little while to get done. . . Like 30 percent of the time I’m actually taking care of the patient, and 70 percent, I’m taking care of all the paperwork needs that they have. (Physician)Carlberg-Racich (2016), PeerJ, DOI 10.7717/peerj.16/Despite the time barrier, the advanced practice nurses were very optimistic about incorporating Harm Reduction counseling into practice, Thonzonium (bromide) supplier although many agreed that physicians may not have the time to do so and that other clinic staff would need to be involved for successful implementation, as in these statements: I think we’re doing a lot of it. There is more that we can do. I think using this kind of teaching tool would be really good, using a DVD would be good. I think it would have to have a certain class or a setting. Some of the things I could do, some of the tools, you know, a little thing here, a little thing there, because it would take up a lot of time in a regular visit, but I think it could be incorporated very easily. I think it would be really great, really, really great. (Nurse Practitioner) I think it’s not only feasible, I think it should be. We actually do have the luxury of time so much more so than many of our colleagues in many settings. We can bring people back more often medically, when it’s really a mental health issue or a substance use issue. (Nurse Practitioner) These quotes illustrate the potential for nurse practitioners to act as champions in moving implementation forward; however, patients have lingering concerns to address.The patient as a barrier Clinicians also cited patient-related barriers in their interviews, from getting them to show up for appointments, adhere to medications, or recognize the health problems that their use may cause. In these descriptions of challenges and barriers, clinicians often seemed suspicious of the motives of their own patients. Common challenges are illustrated in these quotes by different clinicians:The biggest thing is people coming back for follow up, that’s the biggest challenge. Even with all of this stuff being put in place, if clients don’t come back to receive the services, it’s extremely hard, and the biggest carrot or the stick, the L868275 biological activity reason why they come back for primary care is `cause they got to have it in order to get those other services. If they want the.Be good for a group discussion. . . just because I think time wise I think during clinic, it would be very lengthy. They would all want to try it (the demonstration with equipment). (Physician) For any integration to occur at the physician level, a paradigm shift in role may need to occur, as well as additional time for visits. The challenges are really more of a time factor because you’re trying to do it during clinic hours when other patients are waiting to be seen. And it seems like the time flies when you’re in the room with a patient. I don’t know how people see patients in 10 min. (Physician) The time barrier also seemed to be commonly linked to the frustration with other pressing responsibilities, such as paperwork, which interfere with providing more extensive clinical care services. This may be of particular concern in a publicly-funded clinic, whose paperwork requirements and grant writing are often completed by clinical leadership, and require time away from patients to complete. Whether it’s a form to go to the dentist or whatever it is you need, we take care of it, so it isn’t the actual hands on with the patient. A lot of times, it’s the paperwork that takes you a little while to get done. . . Like 30 percent of the time I’m actually taking care of the patient, and 70 percent, I’m taking care of all the paperwork needs that they have. (Physician)Carlberg-Racich (2016), PeerJ, DOI 10.7717/peerj.16/Despite the time barrier, the advanced practice nurses were very optimistic about incorporating Harm Reduction counseling into practice, although many agreed that physicians may not have the time to do so and that other clinic staff would need to be involved for successful implementation, as in these statements: I think we’re doing a lot of it. There is more that we can do. I think using this kind of teaching tool would be really good, using a DVD would be good. I think it would have to have a certain class or a setting. Some of the things I could do, some of the tools, you know, a little thing here, a little thing there, because it would take up a lot of time in a regular visit, but I think it could be incorporated very easily. I think it would be really great, really, really great. (Nurse Practitioner) I think it’s not only feasible, I think it should be. We actually do have the luxury of time so much more so than many of our colleagues in many settings. We can bring people back more often medically, when it’s really a mental health issue or a substance use issue. (Nurse Practitioner) These quotes illustrate the potential for nurse practitioners to act as champions in moving implementation forward; however, patients have lingering concerns to address.The patient as a barrier Clinicians also cited patient-related barriers in their interviews, from getting them to show up for appointments, adhere to medications, or recognize the health problems that their use may cause. In these descriptions of challenges and barriers, clinicians often seemed suspicious of the motives of their own patients. Common challenges are illustrated in these quotes by different clinicians:The biggest thing is people coming back for follow up, that’s the biggest challenge. Even with all of this stuff being put in place, if clients don’t come back to receive the services, it’s extremely hard, and the biggest carrot or the stick, the reason why they come back for primary care is `cause they got to have it in order to get those other services. If they want the.
