George Spady Society, Edmonton, Alberta; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia.
Department of Emergency Medicine, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia; Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia.
Ann Emerg Med. 2023 Jul;82(1):1-10. doi: 10.1016/j.annemergmed.2023.02.007. Epub 2023 Mar 25.
We described the experiences and preferences of people with opioid use disorder who access emergency department (ED) services regarding ED care and ED-based interventions.
Between June and September 2020, we conducted phone or in-person semistructured qualitative interviews with patients recently discharged from 2 urban EDs in Vancouver, BC, Canada, to explore experiences and preferences of ED care and ED-based opioid use disorder interventions. We recruited participants from a cohort of adults with opioid use disorder who were participating in an ED-initiated outreach program. We transcribed audio recordings verbatim. We iteratively developed a thematic coding structure, with interim analyses to assess for thematic saturation. Two team members with lived experience of opioid use provided feedback on content, wording, and analysis throughout the study.
We interviewed 19 participants. Participants felt discriminated against for their drug use, which led to poorer perceived health care and downstream ED avoidance. Participants desired to be treated like ED patients who do not use drugs and to be more involved in their ED care. Participants nevertheless felt comfortable discussing their substance use with ED staff and valued continuous ED operating hours. Regarding opioid use disorder treatment, participants supported ED-based buprenorphine/naloxone programs but also suggested additional options (eg, different initiation regimens and settings and other opioid agonist therapies) to facilitate further treatment uptake.
Based on participant experiences, we recommend addressing potentially stigmatizing practices, increasing patient involvement in their care during ED visits, and increasing access to various opioid use disorder-related treatments and community support.
我们描述了最近从加拿大不列颠哥伦比亚省温哥华的 2 家城市急诊部出院的阿片类药物使用障碍患者对急诊部护理和基于急诊部的干预措施的体验和偏好。
在 2020 年 6 月至 9 月期间，我们通过电话或面对面的半结构化定性访谈，对最近从加拿大不列颠哥伦比亚省温哥华的 2 家城市急诊部出院的患者进行了访谈，以探讨急诊部护理和基于急诊部的阿片类药物使用障碍干预措施的体验和偏好。我们从参加急诊部发起的外展计划的阿片类药物使用障碍成年人队列中招募参与者。我们逐字转录音频记录。我们迭代开发了一个主题编码结构，进行中期分析以评估主题是否达到饱和。两名有阿片类药物使用经验的团队成员在整个研究过程中对内容、措辞和分析提供了反馈。
我们采访了 19 名参与者。参与者因使用毒品而感到歧视，导致他们对医疗保健的感知较差，并导致他们后续避开急诊部。参与者希望像不使用毒品的急诊部患者一样接受治疗，并更多地参与他们的急诊部护理。然而，参与者觉得在急诊部与工作人员讨论他们的药物使用情况很舒服，并重视急诊部的持续运营时间。关于阿片类药物使用障碍治疗，参与者支持基于急诊部的丁丙诺啡/纳洛酮方案，但也提出了其他选择（例如，不同的起始方案和设置以及其他阿片类激动剂疗法），以促进进一步的治疗。
根据参与者的经验，我们建议解决潜在的污名化做法，增加患者在急诊就诊期间对自身护理的参与度，并增加获得各种阿片类药物使用障碍相关治疗和社区支持的机会。
