Incze Michael A, Anderson Tatum, Hansen Annika M, Szczotka Kathryn, Stolebarger Laura, Tuckett Stephanie, Fox Shanaya, Bell Carolyn, Galyean Patrick, Babbel Danielle, Zickmund Susan
Division of General Internal Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
J Gen Intern Med. 2025 May 20. doi: 10.1007/s11606-025-09614-3.
Hospitalizations are common among people with substance use disorders (SUD). Transitioning to follow-up medical and SUD care after discharge is a complex process affected by numerous medical, environmental, and psychosocial factors. Little is known about the experiences of patients with SUD during post-hospitalization care transitions.
We sought to better understand the care transition experiences of people with SUD in the immediate post-hospitalization period.
We conducted a qualitative study at a single academic hospital site.
We interviewed 25 recently hospitalized individuals with a SUD.
Participants were recruited during their hospitalization, and semi-structured interviews were completed via telephone 1-3 weeks after hospital discharge. Interviews were transcribed verbatim and coded. Thematic analysis was performed to inductively extract key themes from coded transcripts.
We identified six themes pertaining to post-hospitalization care transition experiences: (1) the timing and circumstances of hospital discharge were often unpredictable, which could be destabilizing for patients; (2) careful planning and thorough communication by hospital care teams at discharge were valued by patients but happened inconsistently; (3) substance use disorder treatment was desired and offered frequently via a spectrum of active and passive approaches; (4) patients faced multifarious challenges to following through with a care plan after discharge; (5) community supports and a sense of connection are key facilitators of SUD and medical care linkage after hospital discharge; and (6) proactive outreach, individualized care plans, and continuity of care are valued during post-hospitalization care transitions.
Our themes suggest several distinct and actionable steps to improve post-hospitalization care transitions based on the perspectives of people with SUD who were actively transitioning care. In the hospital, SUD treatment initiation, proactive planning around discharge, and predictability were valued. In the outpatient setting, a supportive community, assistance with basic amenities, and post-discharge outreach were valued.
住院治疗在物质使用障碍（SUD）患者中很常见。出院后过渡到后续医疗和物质使用障碍护理是一个复杂的过程，受到众多医疗、环境和心理社会因素的影响。对于物质使用障碍患者在住院后护理过渡期间的经历知之甚少。
我们试图更好地了解物质使用障碍患者在住院后即刻期间的护理过渡经历。
我们在一个学术医院地点进行了一项定性研究。
我们采访了25名最近住院的物质使用障碍患者。
在患者住院期间招募参与者，并在出院后1至3周通过电话完成半结构化访谈。访谈逐字记录并编码。进行主题分析以从编码的记录中归纳提取关键主题。
我们确定了与住院后护理过渡经历相关的六个主题：（1）出院的时间和情况通常不可预测，这可能使患者感到不稳定；（2）患者重视医院护理团队在出院时进行仔细规划和充分沟通，但这种情况并不一致；（3）患者希望获得物质使用障碍治疗，并且经常通过一系列主动和被动方法提供治疗；（4）患者在出院后执行护理计划面临各种挑战；（5）社区支持和联系感是出院后物质使用障碍与医疗护理联系的关键促进因素；（6）在住院后护理过渡期间，主动外联、个性化护理计划和护理连续性受到重视。
我们的主题基于正在积极过渡护理的物质使用障碍患者的观点，提出了几个不同且可采取行动的步骤，以改善住院后护理过渡。在医院里，启动物质使用障碍治疗、围绕出院进行主动规划和可预测性受到重视。在门诊环境中，支持性社区、基本生活设施协助和出院后外联受到重视。
