Thakarar Kinna, Kohut Michael, Stoddard Henry, Burris Deb, Chessa Frank, Sikka Monica K, Solomon Daniel A, Kershaw Colleen M, Eaton Ellen, Hutchinson Rebecca, Fairfield Kathleen M, Friedmann Peter, Stopka Thomas J
Department of Medicine, Tufts University School of Medicine, Boston, MA 02111, USA.
Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME, USA.
Ther Adv Infect Dis. 2023 Apr 3;10:20499361231165108. doi: 10.1177/20499361231165108. eCollection 2023 Jan-Dec.
The prevalence of injection drug use (IDU)-associated infections and associated hospitalizations has been increasing for nearly two decades. Due to issues ranging from ongoing substance use to peripherally inserted central catheter safety, many clinicians find discharge decision-making challenging. Typically, clinicians advise patients to remain hospitalized for several weeks for intravenous antimicrobial treatment; however, some patients may desire other antimicrobial treatment options. A structured conversation guide, delivered by infectious disease physicians, intended to inform hospital discharge decisions has the potential to enhance patient participation in decisions. We developed a conversation guide in order to: (1) investigate its feasibility and acceptability and (2) examine experiences, outcomes, and lessons learned from use of the guide.
We interviewed physicians after they each piloted the conversation guide with two patients. We interviewed patients immediately after the conversation and again 4-6 weeks later. Two analysts indexed transcriptions and used the framework method to identify and organize relevant information. We conducted retrospective chart review to corroborate and contextualize qualitative data.
Eight patients and four infectious disease physicians piloted the conversation guide. All patients ( = 8) completed antimicrobial treatment. Nearly all participants believed the conversation guide was important for incorporating patient values and preferences. Patients reported an increased sense of autonomy, but felt post-discharge needs could be better addressed. Physician participants identified the guide's long length and inclusion of pain management as areas for improvement.
A novel conversation guide to inform hospital discharge decision-making for patients with IDU-associated infections was feasible, acceptable, and fostered the incorporation of patient preferences and values into decisions. While we identified areas for improvement, overall participants believed that this novel conversation guide helped to improve patient care and autonomy.
近二十年来，注射吸毒（IDU）相关感染及相关住院率一直在上升。由于存在从持续吸毒到外周静脉穿刺中心静脉导管安全等一系列问题，许多临床医生发现做出出院决策具有挑战性。通常，临床医生建议患者住院数周进行静脉抗菌治疗；然而，一些患者可能希望有其他抗菌治疗选择。由传染病医生提供的结构化谈话指南旨在为出院决策提供信息，有可能增强患者对决策的参与度。我们制定了一份谈话指南，目的是：（1）调查其可行性和可接受性；（2）检查使用该指南的经验、结果和教训。
在每位医生对两名患者试用谈话指南后，我们对他们进行了访谈。在谈话结束后立即对患者进行访谈，并在4 - 6周后再次访谈。两名分析人员对访谈记录进行索引，并使用框架方法识别和整理相关信息。我们进行了回顾性病历审查，以证实定性数据并将其置于背景中。
八名患者和四名传染病医生试用了谈话指南。所有患者（n = 8）均完成了抗菌治疗。几乎所有参与者都认为谈话指南对于纳入患者价值观和偏好很重要。患者报告自主权有所增强，但觉得出院后的需求可以得到更好的满足。参与的医生指出指南篇幅过长以及纳入疼痛管理是需要改进的方面。
一份用于为IDU相关感染患者出院决策提供信息的新型谈话指南是可行的、可接受的，并有助于将患者偏好和价值观纳入决策。虽然我们确定了需要改进的方面，但总体而言，参与者认为这份新型谈话指南有助于改善患者护理和自主权。
