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Health care professional perspectives on discharging hospitalized patients with injection drug use-associated infections
BACKGROUND: Patients with injection drug use (IDU)-associated infections traditionally experience prolonged hospitalizations, which often result in negative experiences and bad outcomes. Harm reduction approaches that value patient autonomy and shared decision-making regarding outpatient treatment o...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9549088/ https://www.ncbi.nlm.nih.gov/pubmed/36225855 http://dx.doi.org/10.1177/20499361221126868 |
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author | Moore, Nichole Kohut, Michael Stoddard, Henry Burris, Debra Chessa, Frank Sikka, Monica K. Solomon, Daniel Kershaw, Colleen M. Eaton, Ellen Hutchinson, Rebecca Fairfield, Kathleen M. Stopka, Thomas J. Friedmann, Peter Thakarar, Kinna |
author_facet | Moore, Nichole Kohut, Michael Stoddard, Henry Burris, Debra Chessa, Frank Sikka, Monica K. Solomon, Daniel Kershaw, Colleen M. Eaton, Ellen Hutchinson, Rebecca Fairfield, Kathleen M. Stopka, Thomas J. Friedmann, Peter Thakarar, Kinna |
author_sort | Moore, Nichole |
collection | PubMed |
description | BACKGROUND: Patients with injection drug use (IDU)-associated infections traditionally experience prolonged hospitalizations, which often result in negative experiences and bad outcomes. Harm reduction approaches that value patient autonomy and shared decision-making regarding outpatient treatment options may improve outcomes. We sought to identify health care professionals (HCPs) perspectives on the barriers to offering four different options to hospitalized people who use drugs (PWUD): long-term hospitalization, oral antibiotics, long-acting antibiotics at an infusion center, and outpatient parenteral antibiotics. METHODS: We recruited HCPs (n = 19) from a single tertiary care center in Portland, Maine. We interviewed HCPs involved with discharge decision-making and other HCPs involved in the specialized care of PWUD. Semi-structured interviews elicited lead HCP values, preferences, and concerns about presenting outpatient antimicrobial treatment options to PWUD, while support HCPs provided contextual information. We used the iterative categorization approach to code and thematically analyze transcripts. RESULTS: HCPs were willing to present outpatient treatment options for patients with IDU-associated infections, yet several factors contributed to reluctance. First, insufficient resources, such as transportation, may make these options impractical. However, HCPs may be unaware of existing community resources or viable treatment options. They also may believe the hospital protects patients, and that discharging patients into the community exposes them to structural harms. Some HCPs are concerned that patients with substance use disorder will not make ‘good’ decisions regarding outpatient antimicrobial options. Finally, there is uncertainty about how responsibility for offering outpatient treatment is shared across changing care teams. CONCLUSION: HCPs perceive many barriers to offering outpatient care for people with IDU-associated infections, but with appropriate interventions to address their concerns, may be open to considering more options. This study provides important insights and contextual information that can help inform specific harm reduction interventions aimed at improving care of people with IDU-associated infections. |
format | Online Article Text |
id | pubmed-9549088 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-95490882022-10-11 Health care professional perspectives on discharging hospitalized patients with injection drug use-associated infections Moore, Nichole Kohut, Michael Stoddard, Henry Burris, Debra Chessa, Frank Sikka, Monica K. Solomon, Daniel Kershaw, Colleen M. Eaton, Ellen Hutchinson, Rebecca Fairfield, Kathleen M. Stopka, Thomas J. Friedmann, Peter Thakarar, Kinna Ther Adv Infect Dis Infections Associated with Substance Use and Related Behaviors BACKGROUND: Patients with injection drug use (IDU)-associated infections traditionally experience prolonged hospitalizations, which often result in negative experiences and bad outcomes. Harm reduction approaches that value patient autonomy and shared decision-making regarding outpatient treatment options may improve outcomes. We sought to identify health care professionals (HCPs) perspectives on the barriers to offering four different options to hospitalized people who use drugs (PWUD): long-term hospitalization, oral antibiotics, long-acting antibiotics at an infusion center, and outpatient parenteral antibiotics. METHODS: We recruited HCPs (n = 19) from a single tertiary care center in Portland, Maine. We interviewed HCPs involved with discharge decision-making and other HCPs involved in the specialized care of PWUD. Semi-structured interviews elicited lead HCP values, preferences, and concerns about presenting outpatient antimicrobial treatment options to PWUD, while support HCPs provided contextual information. We used the iterative categorization approach to code and thematically analyze transcripts. RESULTS: HCPs were willing to present outpatient treatment options for patients with IDU-associated infections, yet several factors contributed to reluctance. First, insufficient resources, such as transportation, may make these options impractical. However, HCPs may be unaware of existing community resources or viable treatment options. They also may believe the hospital protects patients, and that discharging patients into the community exposes them to structural harms. Some HCPs are concerned that patients with substance use disorder will not make ‘good’ decisions regarding outpatient antimicrobial options. Finally, there is uncertainty about how responsibility for offering outpatient treatment is shared across changing care teams. CONCLUSION: HCPs perceive many barriers to offering outpatient care for people with IDU-associated infections, but with appropriate interventions to address their concerns, may be open to considering more options. This study provides important insights and contextual information that can help inform specific harm reduction interventions aimed at improving care of people with IDU-associated infections. SAGE Publications 2022-10-06 /pmc/articles/PMC9549088/ /pubmed/36225855 http://dx.doi.org/10.1177/20499361221126868 Text en © The Author(s), 2022 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Infections Associated with Substance Use and Related Behaviors Moore, Nichole Kohut, Michael Stoddard, Henry Burris, Debra Chessa, Frank Sikka, Monica K. Solomon, Daniel Kershaw, Colleen M. Eaton, Ellen Hutchinson, Rebecca Fairfield, Kathleen M. Stopka, Thomas J. Friedmann, Peter Thakarar, Kinna Health care professional perspectives on discharging hospitalized patients with injection drug use-associated infections |
title | Health care professional perspectives on discharging hospitalized
patients with injection drug use-associated infections |
title_full | Health care professional perspectives on discharging hospitalized
patients with injection drug use-associated infections |
title_fullStr | Health care professional perspectives on discharging hospitalized
patients with injection drug use-associated infections |
title_full_unstemmed | Health care professional perspectives on discharging hospitalized
patients with injection drug use-associated infections |
title_short | Health care professional perspectives on discharging hospitalized
patients with injection drug use-associated infections |
title_sort | health care professional perspectives on discharging hospitalized
patients with injection drug use-associated infections |
topic | Infections Associated with Substance Use and Related Behaviors |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9549088/ https://www.ncbi.nlm.nih.gov/pubmed/36225855 http://dx.doi.org/10.1177/20499361221126868 |
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