Vasishta Shilpa, Jawa Raagini, Kurz Sarah, Nolan Nathanial S
Division of Infectious Diseases, Montefiore Medical Center, New York, New York, USA.
Center for Research on Healthcare, Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Open Forum Infect Dis. 2024 Sep 24;11(10):ofae544. doi: 10.1093/ofid/ofae544. eCollection 2024 Oct.
Infectious complications of substance use are increasingly encountered in infectious diseases (ID) clinical care. In this study, we surveyed ID fellows in the United States to assess training experiences, clinical practices, and perspectives in caring for people who use drugs (PWUD).
An 18-item survey was distributed to ID fellows via email and social media platforms. Four focus groups were conducted with a subset of participants to elucidate themes in fellowship experiences and training needs.
Among 196 survey respondents (estimated 24% response rate), all reported caring for PWUD in ID fellowship. Forty-nine percent received some formal fellowship-based didactics around care of PWUD, and 64% worked with faculty seen as advocates for PWUD. Integrated care practices for PWUD were infrequently employed: 50% offered risk reduction counseling, and 33% discussed medications for opioid use disorders, naloxone, or HIV preexposure prophylaxis. Risk reduction counseling was felt to be "extremely" within scope of ID practice (69%), although comfort level with this skill was low; fellows' likelihood of offering counseling was significantly associated with their comfort ( ≤ .0001). Common themes in caring for PWUD included an expanded role for ID consultants, a lack of formalized training, and benefits of developing dedicated opportunities in this field.
ID fellows frequently care for PWUD but may have gaps in knowledge or comfort that affect care practices. Increased fellowship training in the care of PWUD has potential to improve clinical practices and support growing interest in this field among current and prospective ID fellows.
物质使用的感染性并发症在传染病（ID）临床护理中越来越常见。在本研究中，我们对美国的传染病专科住院医师进行了调查，以评估他们在照顾吸毒者（PWUD）方面的培训经历、临床实践和观点。
通过电子邮件和社交媒体平台向传染病专科住院医师发放了一份包含18个条目的调查问卷。对一部分参与者进行了4个焦点小组讨论，以阐明专科住院医师培训经历和培训需求中的主题。
在196名调查受访者中（估计回复率为24%），所有人都报告在传染病专科住院医师培训期间照顾过吸毒者。49%的人接受过一些围绕吸毒者护理的正式专科住院医师培训教学，64%的人与被视为吸毒者倡导者的教员合作过。针对吸毒者的综合护理实践很少采用：50%提供降低风险咨询，33%讨论过用于阿片类药物使用障碍、纳洛酮或艾滋病毒暴露前预防的药物。69%的人认为降低风险咨询“完全”属于传染病实践范围，尽管对这项技能的掌握程度较低；专科住院医师提供咨询的可能性与他们的掌握程度显著相关（≤.0001）。照顾吸毒者的常见主题包括传染病顾问的角色扩大、缺乏正规培训以及在该领域开发专门机会的好处。
传染病专科住院医师经常照顾吸毒者，但可能在知识或掌握程度上存在差距，从而影响护理实践。增加针对吸毒者护理的专科住院医师培训有可能改善临床实践，并支持当前和未来传染病专科住院医师对该领域日益增长的兴趣。
