School of Occupational Therapy, Faculty of Health, Dalhousie University, Forrest Building, Room 211, 5869 University Ave, PO Box 15000, Halifax, NS, B3H 4R2, Canada.
Centre for Health Care Ethics (CHCE), Canada; School of Nursing, Lakehead University, Canada.
Soc Sci Med. 2021 Jul;281:114071. doi: 10.1016/j.socscimed.2021.114071. Epub 2021 May 24.
This article presents demographic and care factors related to persons who are substance-involved and require inpatient administration of intravenous antibiotics.
This study was conducted to explore healthcare responses to support substance-involved inpatients, through exploration of documented client outcomes, healthcare provider accounts, and representation of clients through documentation.
METHOD(S): A patient-oriented research team undertook this multiple methods, exploratory study. A health record review included people admitted to a complex continuing care hospital, within a 2-year period, for long-term antibiotic treatment and concurrent illicit substance use. Correlations were examined between whether or not clients were discharged against medical advice (AMA) in comparison to demographic, medical, and care-related factors. Qualitative analysis of narrative health record data was undertaken. Semi-structured interviews of healthcare providers and decision makers were conducted.
Twenty-five people met recruitment criteria for health record review; three people were admitted twice, resulting in 28 admissions. Interviews with seven healthcare providers and decision makers uncovered themes of client autonomy, professional liability, client responsibility, the "right" service, and burnout, hopelessness, and helplessness.
Recommended strategies to effectively respond to substance use among clients admitted for general medical concerns are: i) support inpatients with complex health needs, including substance use, ii) ensure substance use and addiction services are integrated into all inpatient practice areas, iii) support effective harm reduction practices for hospital-admitted clients, and iv) develop robust policies and protocols to support healthcare providers and inpatients.
本文介绍了与需要住院静脉注射抗生素的物质滥用者相关的人口统计学和护理因素。
本研究旨在通过探索记录的客户结果、医疗保健提供者的描述以及通过文档对客户的描述，探索支持物质滥用住院患者的医疗保健反应。
一个以患者为中心的研究团队进行了这项多方法、探索性研究。对在两年内因长期抗生素治疗和同时使用非法物质而住院的复杂持续护理医院的患者进行了病历回顾。检查了客户是否因医疗建议（AMA）出院与人口统计学、医疗和护理相关因素之间的相关性。对病历数据进行了定性分析。对医疗保健提供者和决策者进行了半结构化访谈。
符合健康记录审查标准的 25 人；有 3 人两次入院，共 28 次入院。对 7 名医疗保健提供者和决策者的访谈揭示了客户自主权、专业责任、客户责任、“正确”服务以及倦怠、绝望和无助的主题。
为有效应对因一般医疗问题住院的患者的物质使用问题，建议采取以下策略：i）为有复杂健康需求的患者（包括物质使用）提供支持，ii）确保将物质使用和成瘾服务纳入所有住院治疗领域，iii）为住院患者提供有效的减少伤害措施，iv）制定强有力的政策和协议，为医疗保健提供者和患者提供支持。
