School of Public Health, University of Alberta, Edmonton, AB, Canada.
Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada.
BMC Health Serv Res. 2022 Sep 8;22(1):1138. doi: 10.1186/s12913-022-08498-x.
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.
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.
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.
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.
使用毒品且结构脆弱的人（例如，经历不稳定和/或缺乏住房）经常会寻求急性护理。然而，急性护理系统和提供者可能无法在住院期间有效地解决社会需求。我们的目标是：1）探讨社会服务提供者对解决这一患者群体社会需求的看法；2）确定社会服务提供者建议改善患者护理的可能策略。
我们于 2018 年 8 月 8 日至 2019 年 1 月 24 日在加拿大西部一家大型城市急性护理医院完成了 18 次与社会服务提供者（例如社会工作者、过渡协调员、同伴支持工作者）的半结构化访谈。访谈探讨了工作人员在向使用毒品的结构脆弱患者提供社会服务方面的经验，以及医院和社区社会服务之间的连续性。我们进行了潜在内容分析，并根据社会生态模式组织了我们的发现。
参与者对解决社会需求的患者障碍的看法存在分歧。一些提供者将不良结果归咎于患者的缺陷，而另一些提供者则强调阻碍患者获得社会服务能力的结构性因素。在医院内部，一些参与者认为急性护理不是解决社会需求的合适场所，但大多数参与者认为住院为与结构脆弱的患者建立关系提供了独特的机会。参与者描述了社区中缺乏为使用毒品的人提供住房和经济支持如何限制了急性护理中成功提供社会服务。他们确定了潜在的政策解决方案，例如建立同时解决医疗、收入和药物使用需求的住房支持。
需要进行广泛的政策改革，以改善对使用毒品的结构脆弱患者的护理，包括：1）结束急性护理对社会服务的矛盾态度；2）解决住房和经济支持方面多层次的差距；3）实施基于医院的“住房优先”团队；以及，4）提供具有综合药物使用管理的亚急性护理。
