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Social service providers’ perspectives on caring for structurally vulnerable hospital patients who use drugs: a qualitative study

BACKGROUND: People who use drugs and are structurally vulnerable (e.g., experiencing unstable and/or lack of housing) frequently access acute care. However, acute care systems and providers may not be able to effectively address social needs during hospitalization. Our objectives were to: 1) explore...

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Autores principales: Gehring, Nicole D., Speed, Kelsey A., Dong, Kathryn, Pauly, Bernie, Salvalaggio, Ginetta, Hyshka, Elaine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9461250/
https://www.ncbi.nlm.nih.gov/pubmed/36076267
http://dx.doi.org/10.1186/s12913-022-08498-x
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author Gehring, Nicole D.
Speed, Kelsey A.
Dong, Kathryn
Pauly, Bernie
Salvalaggio, Ginetta
Hyshka, Elaine
author_facet Gehring, Nicole D.
Speed, Kelsey A.
Dong, Kathryn
Pauly, Bernie
Salvalaggio, Ginetta
Hyshka, Elaine
author_sort Gehring, Nicole D.
collection PubMed
description BACKGROUND: People who use drugs and are structurally vulnerable (e.g., experiencing unstable and/or lack of housing) frequently access acute care. However, acute care systems and providers may not be able to effectively address social needs during hospitalization. Our objectives were to: 1) explore social service providers’ perspectives on addressing social needs for this patient population; and 2) identify what possible strategies social service providers suggest for improving patient care. METHODS: We completed 18 semi-structured interviews with social service providers (e.g., social workers, transition coordinators, peer support workers) at a large, urban acute care hospital in Western Canada between August 8, 2018 and January 24, 2019. Interviews explored staff experiences providing social services to structurally vulnerable patients who use drugs, as well as continuity between hospital and community social services. We conducted latent content analysis and organized our findings in relation to the socioecological model. RESULTS: Tensions emerged on how participants viewed patient-level barriers to addressing social needs. Some providers blamed poor outcomes on perceived patient deficits, while others emphasized structural factors that impede patients’ ability to secure social services. Within the hospital, some participants felt that acute care was not an appropriate location to address social needs, but most felt that hospitalization affords a unique opportunity to build relationships with structurally vulnerable patients. Participants described how a lack of housing and financial supports for people who use drugs in the community limited successful social service provision in acute care. They identified potential policy solutions, such as establishing housing supports that concurrently address medical, income, and substance use needs. CONCLUSIONS: Broad policy changes are required to improve care for structurally vulnerable patients who use drugs, including: 1) ending acute care’s ambivalence towards social services; 2) addressing multi-level gaps in housing and financial support; 3) implementing hospital-based Housing First teams; and, 4) offering sub-acute care with integrated substance use management. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-08498-x.
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spelling pubmed-94612502022-09-10 Social service providers’ perspectives on caring for structurally vulnerable hospital patients who use drugs: a qualitative study Gehring, Nicole D. Speed, Kelsey A. Dong, Kathryn Pauly, Bernie Salvalaggio, Ginetta Hyshka, Elaine BMC Health Serv Res Research BACKGROUND: People who use drugs and are structurally vulnerable (e.g., experiencing unstable and/or lack of housing) frequently access acute care. However, acute care systems and providers may not be able to effectively address social needs during hospitalization. Our objectives were to: 1) explore social service providers’ perspectives on addressing social needs for this patient population; and 2) identify what possible strategies social service providers suggest for improving patient care. METHODS: We completed 18 semi-structured interviews with social service providers (e.g., social workers, transition coordinators, peer support workers) at a large, urban acute care hospital in Western Canada between August 8, 2018 and January 24, 2019. Interviews explored staff experiences providing social services to structurally vulnerable patients who use drugs, as well as continuity between hospital and community social services. We conducted latent content analysis and organized our findings in relation to the socioecological model. RESULTS: Tensions emerged on how participants viewed patient-level barriers to addressing social needs. Some providers blamed poor outcomes on perceived patient deficits, while others emphasized structural factors that impede patients’ ability to secure social services. Within the hospital, some participants felt that acute care was not an appropriate location to address social needs, but most felt that hospitalization affords a unique opportunity to build relationships with structurally vulnerable patients. Participants described how a lack of housing and financial supports for people who use drugs in the community limited successful social service provision in acute care. They identified potential policy solutions, such as establishing housing supports that concurrently address medical, income, and substance use needs. CONCLUSIONS: Broad policy changes are required to improve care for structurally vulnerable patients who use drugs, including: 1) ending acute care’s ambivalence towards social services; 2) addressing multi-level gaps in housing and financial support; 3) implementing hospital-based Housing First teams; and, 4) offering sub-acute care with integrated substance use management. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-08498-x. BioMed Central 2022-09-08 /pmc/articles/PMC9461250/ /pubmed/36076267 http://dx.doi.org/10.1186/s12913-022-08498-x Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Gehring, Nicole D.
Speed, Kelsey A.
Dong, Kathryn
Pauly, Bernie
Salvalaggio, Ginetta
Hyshka, Elaine
Social service providers’ perspectives on caring for structurally vulnerable hospital patients who use drugs: a qualitative study
title Social service providers’ perspectives on caring for structurally vulnerable hospital patients who use drugs: a qualitative study
title_full Social service providers’ perspectives on caring for structurally vulnerable hospital patients who use drugs: a qualitative study
title_fullStr Social service providers’ perspectives on caring for structurally vulnerable hospital patients who use drugs: a qualitative study
title_full_unstemmed Social service providers’ perspectives on caring for structurally vulnerable hospital patients who use drugs: a qualitative study
title_short Social service providers’ perspectives on caring for structurally vulnerable hospital patients who use drugs: a qualitative study
title_sort social service providers’ perspectives on caring for structurally vulnerable hospital patients who use drugs: a qualitative study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9461250/
https://www.ncbi.nlm.nih.gov/pubmed/36076267
http://dx.doi.org/10.1186/s12913-022-08498-x
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