Isbell Linda M, Le Van, Huff Nathan R, Beals Kendall, Tager Julia B, Kimball Ezekiel, Whillock Summer, Boudreaux Edwin D
Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA.
The University of Maine, College of Education and Human Development, Orno, Maine, USA.
Health Serv Res. 2025 Aug;60(4):e14617. doi: 10.1111/1475-6773.14617. Epub 2025 Mar 26.
(1) To investigate the healthcare experiences of individuals with mental health and/or substance use disorders (SUDs) who seek medical care in the emergency department (ED) for physical health concerns (e.g., abdominal pain), and (2) to explore recommendations for improving these patients' care experiences. Although this population suffers from a high disease burden and disproportionately seeks care in the ED, surprisingly little research has examined their experiences.
Qualitative study employing grounded theory and semi-structured interviews with patients with mental health and/or SUD(s) (identified via health records) seeking care for a physical health concern during an ED visit to an academic medical center in the Northeastern USA. Longer follow-up interviews were conducted via telephone. Interviews occurred between February 2018 and January 2019.
We transcribed and coded digital recordings of interviews with 50 patients at two time periods. We used constant comparative analysis throughout interviewing, coding, and analysis.
Most participants were White (80%), non-Hispanic (84%), and female (72%). Three key themes emerged, revealing a broad range of negative and positive patient care experiences that are influenced by provider, treatment, and healthcare system factors. Findings demonstrate that stigma and perceived biases due to mental health and/or SUDs extend to medical care experiences not directly related to these conditions (e.g., dismissive, rushed, unprofessional care, medical errors). Participants also identified positive care experiences (e.g., attentive, communicative, efficient, quality care), which informed recommendations for improving care.
Understanding care experiences of vulnerable patient populations is critically important for informing interventions to improve their healthcare quality and safety. Findings underscore the need for additional education and training for providers, integrated behavioral healthcare, and widespread changes to the healthcare system. Localized interventions that target stigma and mismatches between patients' care expectations and ED capabilities are also needed.
（1）调查患有精神健康和/或物质使用障碍（SUDs）的个体在急诊科（ED）因身体健康问题（如腹痛）寻求医疗护理的就医经历，以及（2）探索改善这些患者就医体验的建议。尽管这一人群疾病负担沉重且在急诊科就医的比例过高，但令人惊讶的是，很少有研究考察过他们的就医经历。
采用扎根理论的定性研究，对患有精神健康和/或物质使用障碍（通过健康记录识别）、在美国东北部一家学术医疗中心急诊科因身体健康问题寻求护理的患者进行半结构化访谈。通过电话进行了更长时间的随访访谈。访谈于2018年2月至2019年1月期间进行。
我们在两个时间段转录并编码了对50名患者访谈的数字录音。在整个访谈、编码和分析过程中，我们采用了持续比较分析。
大多数参与者为白人（80%）、非西班牙裔（84%）且为女性（72%）。出现了三个关键主题，揭示了受提供者、治疗和医疗保健系统因素影响的广泛负面和正面患者护理体验。研究结果表明，因精神健康和/或物质使用障碍导致的耻辱感和感知到的偏见延伸至与这些状况无直接关系的医疗护理体验（如轻视、匆忙、不专业的护理、医疗差错）。参与者还识别出了积极的护理体验（如细心、善于沟通、高效、优质护理），这些为改善护理提供了建议。
了解弱势患者群体的护理体验对于为改善其医疗质量和安全的干预措施提供信息至关重要。研究结果强调了对提供者进行额外教育和培训、整合行为医疗保健以及对医疗保健系统进行广泛变革的必要性。还需要针对耻辱感以及患者护理期望与急诊科能力不匹配的情况进行局部干预。
