?A scarlet letter?: Stigma and other factors affecting trust in the health care system for women seeking substance abuse treatment in a community setting
?A scarlet letter?: Stigma and other factors affecting trust in the health care system for women seeking substance abuse treatment in a community setting
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DOI：
10.1080/08897077.2018.1544184
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发表时间：
2019-04-03
期刊：
影响因子：
3.5
通讯作者：
Schlundt, David
中科院分区：
文献类型：
--
作者：
Cockroft, Joshua D.;Adams, Susie M.;Schlundt, David
背景：在一般人群中，对卫生保健的信任已被证明影响卫生保健利用、对公平待遇的看法和健康结果。关于有物质使用障碍(SUD)病史的个人对医疗保健的信任的文献较为有限，主要是研究患者与提供者的关系。在社区方案中寻求药物滥用治疗的妇女与男性同行和普通民众相比，有更高的既往创伤和健康差距。由于有较高的既往创伤发生率，从理论上讲，这一人群面临着人际信任下降和人际关系改变的高风险。目的：这项研究试图确定影响寻求药物滥用治疗的妇女在社区住宅治疗项目中对卫生保健系统的信任的因素。方法：在2016年11月至2017年8月期间进行了6个客户焦点组(n=30)、1个提供者焦点组(n=7)和2个个体临床管理者访谈(n=2)。对焦点小组和访谈进行录音和转录。编码和编码协调由两个独立的编码员进行。从分类和编码的引文中提取和分析主题。结果：共形成六个主题。影响这一人群对卫生保健系统信任的因素包括：(1)先前的诊断、治疗和结果经验；(2)成瘾的污名；(3)支付和报销结构；(4)患者权利和保护；(5)以效率为导向的护理；和(6)卫生保健系统在成瘾和/或成瘾中的作用。结论：这些主题表明了该人群中女性对医疗保健系统的普遍不信任。不信任受到一种看法的影响，即医疗保健系统提供的医疗服务质量参差不齐，通常是污名化的，负担不起的，效率驱动的，经常影响个人的？苏德。这与先前关于信任SUD患者健康护理的文献是一致的，也是扩展的。未来的研究方向包括正式评估信任对治疗进入和保留等健康结果的影响。
Background: Trust in health care has been shown to influence health care utilization, perceptions of fair treatment, and health outcomes in the general population. The literature on trust in health care in individuals with a history of substance use disorder (SUD) is more limited, primarily examining the patient-provider relationship. Women seeking substance abuse treatment in community-based programs have higher rates of prior trauma and health disparities compared with male counterparts and the general population. With higher rates of prior trauma, this population is theoretically at high risk of decreased interpersonal trust and altered interpersonal relationships. Objective: This study sought to identify factors influencing trust in the health care system for women seeking substance abuse treatment in a community-based residential treatment program. Methods: Six client focus groups (n?=?30), 1 provider focus group (n?=?7), and 2 individual clinical administrator interviews (n?=?2) were conducted between November 2016 and August 2017. Focus groups and interviews were audio recorded and transcribed. Coding and coding reconciliation were conducted by 2 independent coders. Themes were extracted and analyzed from sorted and coded quotes. Results: Six themes emerged. Factors that influence trust in the health care system in this population include (1) prior experiences with diagnosis, treatment, and outcomes; (2) stigma of addiction; (3) payment and reimbursement structure; (4) patient rights and protections; (5) efficiency-driven care; and (6) the health care system's role in causing and/or enabling addiction. Conclusions: These themes demonstrate a general distrust of the health care system by women in this population. Distrust is influenced by a perception of a health care system providing care that is variable in quality, often stigmatizing, unaffordable, efficiency driven, and often influencing individuals? SUD. This aligns with and extends prior literature around trust of health care in individuals with SUD. Future directions in research include formally assessing the impact of trust on health outcomes such as treatment entry and retention.