Opportunities to improve opioid use disorder care for hospitalised patients with endocarditis.
Opportunities to improve opioid use disorder care for hospitalised patients with endocarditis.
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DOI：
10.1136/bmjoq-2023-002420
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发表时间：
2023-12-18
期刊：
影响因子：
1.4
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中科院分区：
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在注射阿片类药物使用增加的推动下，感染性心内膜炎的住院率正在上升，这是一种与注射药物使用相关的感染。在美国，因阿片类药物使用障碍相关感染性心内膜炎(OUD-IE)住院的患者中，每10人中就有1人在医院死亡，每20人中就有1人直接出院。新兴的护理模式揭示了医疗系统满足这些患者复杂的护理需求的机会。我们描述了护理这些患者的工作人员的有前途的做法，并确定了需要改进的领域。我们在2021年10月至2022年3月期间进行了一项1小时半结构化虚拟访谈的定性研究。参与者包括宾夕法尼亚大学医院26名护理OUD-IE患者的医护人员。我们采用了主题分析的方法来指导采访。访谈被数字化记录和转录，并使用NVivo软件进行分析。访谈的特点是三个主要主题：(1)根植于跨学科合作的护理；(2)在不是为治疗OUD而设计的环境中管理OUD及其后遗症；以及(3)临床医生的需求和改变的障碍。这些发现突出了为OUD-IE患者提供高质量治疗的促进者，以及需要改进的关键领域。研究结果增加了医护人员和患者在OUD-IE住院期间和之后导航的复杂性。需要的改变包括培训工作人员与患者谈论住院后恢复使用药物的准备，以及改变阻碍OUD-IE患者进入的出院设施的做法。
Driven by increased injection opioid use, rates of hospitalisation for infective endocarditis, an infection associated with injection drug use, are increasing. In the USA, 1 in 10 hospitalised patients for opioid use disorder-associated infective endocarditis (OUD-IE) die in the hospital and 1 in 20 have a patient-directed discharge. Emerging models of care reveal opportunities for healthcare systems to meet the complex care needs of these patients. We characterised promising practices of staff who care for these patients and identified areas for improvement. We conducted a qualitative study with 1-hour semistructured virtual interviews between October 2021 and March 2022. Participants included 26 healthcare staff who care for patients with OUD-IE at the Hospital of the University of Pennsylvania. We used thematic analysis of interviews guided by an abductive approach. Interviews were digitally recorded and transcribed and analysed using NVivo software. Interviews were characterised by three major themes: (1) care rooted in interdisciplinary collaboration; (2) managing OUD and its sequelae in a setting not designed to treat OUD; and (3) clinician needs and barriers to change. These findings highlight the facilitators of high-quality treatment for patients with OUD-IE, as well as the key areas for improvement. Findings add context to the complexity that both the healthcare staff and patients navigate during and following hospitalisation for OUD-IE. Needed changes include training staff to talk with patients about preparing for a return to drug use following hospitalisation, and changing discharge facilities’ practices that hinder access for patients with OUD-IE.