Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14Th St, Suite 851, Miami, FL, 33136, USA.
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
Addict Sci Clin Pract. 2023 Feb 7;18(1):8. doi: 10.1186/s13722-023-00363-4.
Hospitalizations for severe injection drug use-related infections (SIRIs) are characterized by high costs, frequent patient-directed discharge, and high readmission rates. Beyond the health system impacts, these admissions can be traumatizing to people who inject drugs (PWID), who often receive inadequate treatment for their substance use disorders (SUD). The Jackson SIRI team was developed as an integrated infectious disease/SUD treatment intervention for patients hospitalized at a public safety-net hospital in Miami, Florida in 2020. We conducted a qualitative study to identify patient- and clinician-level perceived implementation barriers and facilitators to the SIRI team intervention.
Participants were patients with history of SIRIs (n = 7) and healthcare clinicians (n = 8) at one implementing hospital (Jackson Memorial Hospital). Semi-structured qualitative interviews were performed with a guide created using the Consolidated Framework for Implementation Research (CFIR). Interviews were transcribed, double coded, and categorized by study team members using CFIR constructs.
Implementation barriers to the SIRI team intervention identified by participants included: (1) complexity of the SIRI team intervention; (2) lack of resources for PWID experiencing homelessness, financial insecurity, and uninsured status; (3) clinician-level stigma and lack of knowledge around addiction and medications for opioid use disorder (OUD); and (4) concerns about underinvestment in the intervention. Implementation facilitators of the intervention included: (1) a non-judgmental, harm reduction-oriented approach; (2) the team's advocacy for PWID as a means of institutional culture change; (3) provision of close post-hospital follow-up that is often inaccessible for PWID; (4) strong communication with patients and their hospital physicians; and (5) addressing diverse needs such as housing, insurance, and psychological wellbeing.
Integration of infectious disease and SUD treatment is a promising approach to managing patients with SIRIs. Implementation success depends on institutional buy-in, holistic care beyond the medical domain, and an ethos rooted in harm reduction across multilevel (inner and outer) implementation contexts.
因严重注射药物使用相关感染（SIRIs）而住院的特点是费用高、频繁出现患者主导的出院以及高再入院率。除了对卫生系统的影响外，这些住院治疗对注射毒品者（PWID）来说可能是创伤性的，他们通常得不到足够的物质使用障碍（SUD）治疗。2020 年，杰克逊 SIRI 团队作为一种综合传染病/SUD 治疗干预措施，在佛罗里达州迈阿密的一家公共安全网医院为住院患者实施。我们进行了一项定性研究，以确定患者和临床医生对 SIRI 团队干预措施的实施障碍和促进因素。
参与者为有 SIRI 病史的患者（n=7）和一家实施医院（杰克逊纪念医院）的医疗保健临床医生（n=8）。使用整合实施研究（CFIR）制定的指南对参与者进行半结构化定性访谈。访谈内容经过转录、双编码，并由研究团队成员使用 CFIR 结构进行分类。
参与者确定的 SIRI 团队干预措施的实施障碍包括：（1）SIRI 团队干预措施的复杂性；（2）无家可归、经济不安全和没有保险的 PWID 缺乏资源；（3）临床医生层面的污名化以及对成瘾和阿片类药物使用障碍（OUD）药物的认识不足；（4）对干预措施投资不足的担忧。干预措施的实施促进因素包括：（1）非评判、以减少伤害为导向的方法；（2）团队倡导 PWID，作为机构文化变革的一种手段；（3）提供 PWID 难以获得的密切住院后随访；（4）与患者及其医院医生的有效沟通；（5）满足住房、保险和心理健康等多样化需求。
将传染病和 SUD 治疗相结合是管理 SIRIs 患者的一种很有前途的方法。实施成功取决于机构的认可、超越医疗领域的全面护理以及基于内外实施环境的减少伤害的理念。
