The results of this study illustrate that low threshold services such as the Health Promotion Unit have the ability to attract injecting drug users not in contact with other drug treatment services.
Some also asked for low threshold services in secondary health care: " Increased contact with psychiatric nurses would give a low threshold offer for referral".
Barriers to and recommendations for improving the end-of-life care system were consistent across the cities included in this study, although the availability of low threshold services in two cities (Ottawa and Toronto) was perceived to minimize some barriers to care.
Participants were recruited either directly from a range of low threshold services, including drop-in centres and needle exchanges, or using indigenous fieldworkers to recruit from the community settings[ 20].
Both systems collected data on those individuals in 'structured treatment services', primarily consisting of substitute prescribing, structured counselling and abstinence based services but excluding low threshold services such as needle exchange and drop in services (for a full explanation of the treatment tiers see Models of Care for Substance Misusers [ 17]).
In each city we did an exhaustive inventory of all structures that provide services to DUs: accommodation services including residential centers, hotel rooms, "sleep-in"; drug treatment centers including methadone maintenance or psychotherapy; low threshold services including needle exchange programs and outreach work teams.
Re-engagement may be further improved by establishing strong linkages between structured treatment and low threshold services such as syringe exchange schemes and through effective information exchange between agencies as drug users leave one service and reappear shortly afterwards in another.
(T23) The respondents pointed out the importance of low threshold services, i.e. services without charges that are easy to reach (via consultation hours, location, phone or email), promptly available and proactive, as well as specific training of the help-providers in care for victims of traumatization to reduce barriers in the actual process of help-seeking.
This paper reports specifically on the findings from the evaluation in respect of the setting up of HHCs in community pharmacies and aims to offer some lessons for other service settings where this option is seen as a way of providing low threshold services which will minimise inequalities in intervention uptake.
