Tompkins Charlotte Ne, Wright Nat Mj, Jones Lesley
Centre for Research in Primary Care, Leeds.
Br J Gen Pract. 2005 Apr;55(513):263-8.
Increasing numbers of injecting drug users are presenting to primary care and a growing number of general practices are specifically providing care for homeless people. Injecting drug users are at the greatest risk of hepatitis C infection and homeless drug misusers, because of their drug-taking behaviour and patterns, have been identified as being at greater risk of harm of blood-borne diseases than the general population. However, little work has been conducted with injecting drug users or homeless people who have hepatitis C and little is known about how the virus may affect them.
To explore the impact of a positive hepatitis C diagnosis on homeless injecting drug users.
This study employed qualitative research. In-depth interviews allowed the exploration of the impact of a potentially life-threatening diagnosis within the context of a person's expressed hierarchy of needs.
A primary care centre for homeless people in the north of England.
In-depth interviews about the impact of a positive hepatitis C diagnosis on their lives were conducted with 17 homeless injecting drug users who had received a positive hepatitis C diagnosis. The interviews were audiotaped, transcribed, and analysed using the framework approach.
Receiving a positive diagnosis for hepatitis C resulted in feelings of shock, devastation, disbelief, anger, and questioning. A positive diagnosis had lasting social, emotional, psychological, behavioural, and physical effects on homeless injecting drug users, even years after the initial diagnosis. Most responders were diagnosed by a doctor in primary care or by hospital staff; however, not all had sought testing and a number were tested while inpatients and were unaware that blood had been taken for hepatitis C virus serology.
The implications for clinical policy and primary care practice are discussed, including the issues of patient choice, confidentiality, and pre- and post-test discussions. Posttest discussions should be followed up with additional social, psychological, and medical support and counselling.
越来越多的注射吸毒者前往初级保健机构就诊，越来越多的全科医疗诊所专门为无家可归者提供护理。注射吸毒者感染丙型肝炎的风险最高，而无家可归的药物滥用者由于其吸毒行为和模式，被认定比普通人群感染血源性疾病的风险更大。然而，针对感染丙型肝炎的注射吸毒者或无家可归者开展的研究很少，对于该病毒如何影响他们也知之甚少。
探讨丙型肝炎诊断呈阳性对无家可归的注射吸毒者的影响。
本研究采用定性研究方法。深度访谈有助于在个人表达的需求层次背景下探讨潜在的危及生命的诊断所产生的影响。
英格兰北部一家为无家可归者服务的初级保健中心。
对17名丙型肝炎诊断呈阳性的无家可归的注射吸毒者进行了关于丙型肝炎诊断呈阳性对其生活影响的深度访谈。访谈进行了录音、转录，并采用框架分析法进行分析。
丙型肝炎诊断呈阳性会导致震惊、崩溃、怀疑、愤怒和质疑等情绪。即使在初次诊断数年之后，阳性诊断对无家可归的注射吸毒者仍有持久的社会、情感、心理、行为和身体影响。大多数受访者是由初级保健医生或医院工作人员诊断的；然而，并非所有人都主动寻求检测，有一些人是在住院期间接受检测的，并且不知道血液已被用于丙型肝炎病毒血清学检测。
讨论了对临床政策和初级保健实践的影响，包括患者选择、保密以及检测前后讨论等问题。检测后讨论应跟进额外的社会、心理和医疗支持及咨询。
