Weill Cornell Medical College, New York, NY, USA.
Department of Medicine, Division of General Internal Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA.
J Gen Intern Med. 2024 Aug;39(11):2087-2096. doi: 10.1007/s11606-024-08745-3. Epub 2024 May 2.
Individuals with substance use disorders (SUDs) are hospitalized in growing numbers. Stigma is pervasive among their hospital providers, and SUD management during medical admissions is often inadequate. However, little is known about how these patients perceive their care quality. In particular, few studies have explored their positive care perceptions or recommendations for improvement.
To explore perspectives on positive aspects, negative aspects, and consequences of care, as well as recommendations for improvement among hospitalized patients with SUDs.
We conducted semi-structured, in-depth bedside interviews (n = 15) with patients who have been diagnosed with a SUD and were admitted to medical or surgical floors of an urban academic medical center.
Interviews explored patients' hospital experiences and recommendations for improvement. The interviews were audio-recorded, transcribed verbatim, and imported into NVivo software. Two reviewers independently coded the transcripts using interpretative phenomenological analysis and inductive thematic analysis according to grounded theory, and recurring themes were identified from the data. Patients' demographic and clinical data were analyzed with descriptive statistics.
Perceived clinical and emotional proficiency were the most important components of positive experiences, whereas perceived bias and stigmatized attitudes, clinical improficiency, and inhumane treatment were characteristic of negative experiences. Such care components were most consequential for patients' emotional well-being, trust, and care quality. Recommendations for improving care included specific suggestions for initiating and promoting continued recovery, educating, and partnering in compassionate care.
Hospitalized patients with SUDs often experience lower quality and less compassionate care linked to pervasive stigma and poor outcomes. Our study highlights under-recognized perspectives from this patient population, including socioemotional consequences of care and recommendations grounded in lived experiences. By striving to advance our care in accordance with patients' viewpoints, we can turn hospitalizations into opportunities for engagement and promoting recovery.
患有物质使用障碍（SUD）的个体数量不断增加，他们在医院的医护人员中普遍存在污名化现象，且在医疗入院期间对 SUD 的管理往往不足。然而，人们对这些患者如何看待他们的护理质量知之甚少。特别是，很少有研究探讨他们对护理的积极看法或改进建议。
探索患有 SUD 的住院患者对护理的积极方面、消极方面和后果的看法，以及对改进的建议。
我们对已被诊断患有 SUD 并被收入城市学术医疗中心内科或外科病房的患者进行了半结构化、深入的床边访谈（n=15）。
访谈探讨了患者的住院经历和改进建议。访谈进行了录音，逐字转录，并导入 NVivo 软件。两位评审员根据扎根理论，使用解释性现象学分析和归纳主题分析独立对转录本进行编码，并从数据中确定反复出现的主题。使用描述性统计对患者的人口统计学和临床数据进行分析。
感知到的临床和情感能力是积极体验的最重要组成部分，而感知到的偏见和污名化态度、临床不熟练和不人道的待遇则是消极体验的特征。这些护理要素对患者的情绪健康、信任和护理质量影响最大。改进护理的建议包括具体建议，如启动和促进持续康复、教育以及以富有同情心的方式合作。
患有 SUD 的住院患者的护理质量往往较低，且缺乏同情心，这与普遍存在的污名化和较差的结果有关。我们的研究突出了这一患者群体中被低估的观点，包括护理的社会情感后果和基于个人经验的建议。通过努力根据患者的观点改进我们的护理，我们可以将住院转变为参与和促进康复的机会。
