Wang V L, Derenoncourt M, Brokus C, Stevens J, Carpenter J, Steck A, Kuo I, Catalanotti J S, Akselrod H, Burgan K, Burkholder G, Eaton E, Masur H, Kottilil S, Rosenthal E, Kattakuzhy S
Research Initiative on Infections in Substance Use, Institute of Human Virology at the University of Maryland School of Medicine, United States of America; Partnership for HIV/AIDS Progress, Clinical Center, National Institutes of Health, United States of America.
Research Initiative on Infections in Substance Use, Institute of Human Virology at the University of Maryland School of Medicine, United States of America; Harvard Medical School, United States of America.
J Subst Use Addict Treat. 2025 Nov;178:209778. doi: 10.1016/j.josat.2025.209778. Epub 2025 Aug 8.
Given the rising rates of morbidity and mortality related to Opioid Use Disorder (OUD), hospitalization may be an opportune time to engage individuals with OUD in treatment and prevention. The 'Continuum of Care in Hospitalized Patients with Opioid Use Disorder and Infectious Complications of Injection Drug Use' ('CHOICE') protocol was a multi-site study developed to understand barriers and facilitators of care for patients with infectious complications of OUD.
The study conducted semi-structured interviews with twenty-four stakeholders (community providers, harm reductionists, and other professionals) from CHOICE sites involved in the continuum of OUD care: Georgia, Maryland, Alabama, and the District of Columbia. The data was coded using qualitative management software (NVivo 11). Subsequent thematic analysis involved a hybrid deductive and inductive approach.
We identified seven key themes, organized through the lens of a Social-Ecologic (SE) Model, an analytical framework that groups themes by level of influence at the individual, institutional, community, and societal/national levels. Major findings from each theme included (1) stigmatization of patients with OUD, and their providers; (2) lack of standardization around evidence-based OUD practices; (3) limited patient and provider resources; (4) poor inter- and intra-institutional communication; (5) the importance of co-localized care and harm reduction; (6) impact of the institutional and pandemic environment; and (7) the restrictive nature of national policies.
These common findings across geographically and policy-diverse clinical sites point to a need for targeted policy, training, and clinical interventions at each SE level, and for standards in OUD care to be developed and prioritized.
鉴于与阿片类药物使用障碍（OUD）相关的发病率和死亡率不断上升，住院治疗可能是促使患有OUD的个体接受治疗和预防的有利时机。“阿片类药物使用障碍住院患者及注射吸毒感染并发症的连续护理”（“CHOICE”）方案是一项多地点研究，旨在了解患有OUD感染并发症患者的护理障碍和促进因素。
该研究对来自参与OUD连续护理的CHOICE地点（佐治亚州、马里兰州、阿拉巴马州和哥伦比亚特区）的24名利益相关者（社区提供者、减少伤害者和其他专业人员）进行了半结构化访谈。使用定性管理软件（NVivo 11）对数据进行编码。随后的主题分析采用了演绎和归纳相结合的方法。
我们确定了七个关键主题，这些主题是通过社会生态（SE）模型这一视角组织起来的，该分析框架按个体、机构、社区和社会/国家层面的影响水平对主题进行分组。每个主题的主要发现包括：（1）对患有OUD的患者及其提供者的污名化；（2）基于证据的OUD实践缺乏标准化；（3）患者和提供者资源有限；（4）机构间和机构内沟通不畅；（5）共同定位护理和减少伤害的重要性；（6）机构和大流行环境的影响；（7）国家政策的限制性。
这些在地理位置和政策各异的临床地点的共同发现表明，需要在每个SE层面进行有针对性的政策、培训和临床干预，并制定和优先考虑OUD护理标准。
