一项对急诊室阿片类药物过量幸存者的定性研究：治疗和未满足需求的观点。
A qualitative study of emergency department patients who survived an opioid overdose: Perspectives on treatment and unmet needs.
机构信息
Department of Emergency Medicine, Yale University, New Haven, Connecticut, USA.
School of Public Health, Yale University, New Haven, Connecticut, USA.
出版信息
Acad Emerg Med. 2021 May;28(5):542-552. doi: 10.1111/acem.14197. Epub 2021 Feb 28.
OBJECTIVE
Emergency medicine clinicians are uniquely positioned to deliver interventions to enhance linkage to evidence-based treatment for opioid use disorder (OUD) in the acute overdose period, yet little is known about patient perspectives to effectively engage patients immediately following opioid overdose. Our objective was to explore patients' perspectives on substance use treatment, perceived needs, and contextual factors that shape the choice of patients seen in the emergency department (ED) to engage with treatment and other patient support services in the acute post-opioid overdose period.
METHODS
We administered a brief quantitative survey and conducted semistructured interviews with 24 adult ED patients receiving care after an acute opioid overdose between June 2016 and August 2017 in an urban, academic ED. We used constant comparison method and thematic analysis to identify themes across four levels of a modified social ecologic model (individual, interpersonal, organizational, and structural).
RESULTS
The mean (±SD) age of the sample was 33.5 (±9.33) years; 83% were White and 12% were Black; 67% were male; and 83% were diagnosed with OUD, with a mean (±SD) of 3.25 (±2.64) self-reported lifetime opioid overdoses. Eight themes were identified as influencing participants' consideration of OUD treatment and other services: (1) perceptions about control of drug use, (2) personal experience with substance use treatment, (3) role of interpersonal relationships, (4) provider communication skills, (5) stigma, (6) availability of ED resources, (7) impact of treatment policies, and (8) support for unmet basic needs.
CONCLUSIONS
Patients receiving ED care following overdose in our ED are willing to discuss their opioid use and its treatment in the ED and report a variety of unmet needs. This work supports a role for ED-based research evaluating a patient-oriented approach to engage patients after opioid overdose.
目的
急诊医学临床医生在急性药物过量期间提供干预措施以加强与阿片类药物使用障碍（OUD）的循证治疗联系的位置独特，但对于如何有效地在阿片类药物过量后立即与患者接触，了解患者的观点知之甚少。我们的目的是探讨患者对物质使用治疗的看法、感知需求以及影响患者选择在急诊部（ED）接受治疗和其他患者支持服务的环境因素，以在急性阿片类药物过量后时期进行治疗。
方法
我们在 2016 年 6 月至 2017 年 8 月期间，在一个城市的学术 ED 中对接受急性阿片类药物过量治疗的 24 名成年 ED 患者进行了简短的定量调查和半结构化访谈。我们使用恒比法和主题分析来确定在一个经过修改的社会生态学模型（个体、人际、组织和结构）的四个层次上的主题。
结果
样本的平均（±SD）年龄为 33.5（±9.33）岁；83%为白人，12%为黑人；67%为男性；83%被诊断为 OUD，平均（±SD）有 3.25（±2.64）次自我报告的终生阿片类药物过量。确定了 8 个主题，这些主题影响参与者对 OUD 治疗和其他服务的考虑：（1）对控制药物使用的看法，（2）对物质使用治疗的个人经验，（3）人际关系的作用，（4）提供者沟通技巧，（5）污名，（6）ED 资源的可用性，（7）治疗政策的影响，以及（8）对未满足的基本需求的支持。
结论
在我们的 ED 中接受过量药物治疗的患者愿意在 ED 中讨论他们的阿片类药物使用及其治疗，并报告了各种未满足的需求。这项工作支持了 ED 基于研究的方法，该方法评估了一种以患者为导向的方法，在阿片类药物过量后使患者参与进来。
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