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
Tufts University School of Medicine, Boston, MA, USA.
Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME, USA.
Ther Adv Infect Dis. 2022 Oct 6;9:20499361221126868. doi: 10.1177/20499361221126868. eCollection 2022 Jan-Dec.
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.
We recruited HCPs ( = 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.
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.
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.
传统上，注射吸毒（IDU）相关感染患者住院时间较长，这往往会带来负面体验和不良后果。重视患者自主权以及关于门诊治疗选择的共同决策的减少伤害方法可能会改善治疗结果。我们试图确定医疗保健专业人员（HCPs）对于向吸毒住院患者（PWUD）提供四种不同选择（长期住院、口服抗生素、在输液中心使用长效抗生素以及门诊胃肠外抗生素）的障碍的看法。
我们从缅因州波特兰市的一家三级医疗中心招募了19名HCPs。我们采访了参与出院决策的HCPs以及参与PWUD专科护理的其他HCPs。半结构化访谈引出了主要HCPs对于向PWUD提供门诊抗菌治疗选择的价值观、偏好和担忧，同时辅助HCPs提供了背景信息。我们使用迭代分类方法对访谈记录进行编码和主题分析。
HCPs愿意为IDU相关感染患者提供门诊治疗选择，但有几个因素导致他们有所顾虑。首先，交通等资源不足可能使这些选择不切实际。然而，HCPs可能不了解现有的社区资源或可行的治疗选择。他们也可能认为医院能保护患者，而将患者出院到社区会使他们面临结构性伤害。一些HCPs担心患有物质使用障碍的患者在门诊抗菌选择方面不会做出“正确”的决定。最后，在不断变化的护理团队之间如何分担提供门诊治疗的责任存在不确定性。
HCPs认为为IDU相关感染患者提供门诊护理存在许多障碍，但通过适当的干预措施来解决他们的担忧，可能会愿意考虑更多选择。本研究提供了重要的见解和背景信息，有助于为旨在改善IDU相关感染患者护理的具体减少伤害干预措施提供参考。
