School of Public Health, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
Department of Emergency Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
PLoS One. 2024 Feb 15;19(2):e0297584. doi: 10.1371/journal.pone.0297584. eCollection 2024.
People who inject drugs in North America often continue to inject while hospitalized, and are at increased risk of premature hospital discharge, unplanned readmission, and death. In-hospital access to sterile injection supplies may reduce some harms associated with ongoing injection drug use. However, access to needle and syringe programs in acute care settings is limited. We explored the implementation of a needle and syringe program integrated into a large urban tertiary hospital in Western Canada. The needle and syringe program was administered by an addiction medicine consult team that offers patients access to specialized clinical care and connection to community services.
We utilized a focused ethnographic design and semi-structured interviews to elicit experiences and potential improvements from 25 hospitalized people who inject drugs who were offered supplies from the needle and syringe program.
Participants were motivated to accept supplies to prevent injection-related harms and access to supplies was facilitated by trust in consult team staff. However, fears of negative repercussions from non-consult team staff, including premature discharge or undesired changes to medication regimes, caused some participants to hesitate or refuse to accept supplies. Participants described modifications to hospital policies regarding inpatient drug use or access to an inpatient supervised consumption service as potential ways to mitigate patients' fears.
Acute care needle and syringe programs may aid hospital providers in reducing harms and improving hospital outcomes for people who inject drugs. However, modifications to hospital policies and settings may be necessary.
在北美，注射吸毒者在住院期间常常继续注射，并且过早出院、非计划性再次入院和死亡的风险增加。在医院获得无菌注射用品可能会减少一些与持续使用注射毒品相关的危害。然而，在急性护理环境中获得针具交换计划的机会有限。我们探讨了在加拿大西部一家大型城市三级医院实施的针具交换计划。该针具交换计划由一个成瘾医学咨询团队管理，为患者提供专门的临床护理和社区服务联系。
我们采用了聚焦的民族志设计和半结构化访谈，从 25 名接受针具交换计划供应的住院注射吸毒者那里收集经验和潜在改进措施。
参与者有接受供应品的动机，以防止与注射相关的危害，并且由于对咨询团队工作人员的信任，供应品的获取得到了促进。然而，一些参与者担心非咨询团队工作人员的负面反应，包括过早出院或不希望改变药物治疗方案，导致他们犹豫不决或拒绝接受供应品。参与者描述了对医院有关住院患者药物使用或获得住院监督消费服务的政策进行修改，作为减轻患者恐惧的潜在方法。
急性护理针具交换计划可以帮助医院提供者减少注射吸毒者的危害并改善医院的结果。然而，可能需要对医院政策和环境进行修改。
