Harm reduction for the treatment of patients with severe injection-related infections: description of the Jackson SIRI Team.
Harm reduction for the treatment of patients with severe injection-related infections: description of the Jackson SIRI Team.
复制标题
DOI：
10.1080/07853890.2021.1993326
复制
发表时间：
2021-12
影响因子：
4.4
通讯作者：
Doblecki-Lewis S
中科院分区：
文献类型：
--
作者：
Serota DP;Tookes HE;Hervera B;Gayle BM;Roeck CR;Suarez E;Forrest DW;Kolber MA;Bartholomew TS;Rodriguez AE;Doblecki-Lewis S
因严重注射相关感染（SIRI）住院治疗，如心内膜炎、骨髓炎、皮肤和软组织感染（SSTI）越来越普遍。经历SIRIs的注射吸毒者（PWID）往往得不到充分的物质使用障碍（SUD）治疗，并且缺乏获得减少伤害服务的机会。这导致长期住院，患者自行出院、再入院和住院后死亡率高。本研究的目的是描述一个集成的“SIRI团队”的发展及其成功的最初障碍和促进因素。杰克逊SIRI团队的建立是为了改善杰克逊纪念医院（位于美国佛罗里达州迈阿密的一家拥有1550张床位的公立医院）的SIRI住院患者在医院和患者层面的治疗效果。SIRI团队在整个医疗保健系统中提供综合传染病和SUD治疗，从住院开始，持续到出院后90天。该团队采用减少伤害的方法，提供护理协调，专注于获得阿片类药物使用障碍（mod）的药物，并利用各种感染和成瘾治疗方式来适应每个患者。在SIRI团队最初的8个月里，21名患者接受了治疗，其中20名患者存活至出院。感染包括骨髓炎、心内膜炎、菌血症/真菌血症、性传播感染和脓毒性关节炎。所有患者都有OUD， 95%的患者使用兴奋剂。所有患者均于mod出院，95%的患者完成了规定的抗生素疗程。出院后90天，25%的患者再次入院，70%的患者报告服用了mod。传染病与成瘾综合治疗是治疗严重注射相关感染的一种新方法。减少伤害应应用于治疗严重注射相关感染的患者，目标是促进抗生素的完成，缓解物质使用障碍，减少再入院。综合传染病和SUD治疗SIRIs的模型有可能改善感染和成瘾结果。提供细心的、以患者为中心的护理，使用减少伤害的方法可以促进这一边缘化人群与医疗保健系统的接触。
Hospitalizations for severe injection-related infections (SIRI), such as endocarditis, osteomyelitis, and skin and soft tissue infections (SSTI) are increasingly common. People who inject drugs (PWID) experiencing SIRIs often receive inadequate substance use disorder (SUD) treatment and lack of access to harm reduction services. This translates into lengthy hospitalizations with high rates of patient-directed discharge, readmissions, and post-hospitalization mortality. The purpose of this study was to describe the development of an integrated “SIRI Team” and its initial barriers and facilitators to success. The Jackson SIRI Team was developed to improve both hospital and patient-level outcomes for individuals hospitalized with SIRIs at Jackson Memorial Hospital, a 1550-bed public hospital in Miami, Florida, United States. The SIRI Team provides integrated infectious disease and SUD treatment across the healthcare system starting from the inpatient setting and continuing for 90-days post-hospital discharge. The team uses a harm reduction approach, provides care coordination, focuses on access to medications for opioid use disorder (MOUD), and utilizes a variety of infection and addiction treatment modalities to suit each individual patient. Over the initial 8-months of the SIRI Team, 21 patients were treated with 20 surviving until discharge. Infections included osteomyelitis, endocarditis, bacteraemia/fungemia, SSTIs, and septic arthritis. All patients had OUD and 95% used stimulants. All patients were discharged on MOUD and 95% completed their prescribed antibiotic course. At 90-days post-discharge, 25% had been readmitted and 70% reported taking MOUD. Integrated infectious disease and addiction treatment is a novel approach to treating severe injection-related infections. Harm reduction should be applied to treating patients with severe injection-related infections with a goal of facilitating antibiotic completion, remission from substance use disorder, and reducing hospital readmissions. A model of integrated infectious disease and SUD care for the treatment of SIRIs has the potential to improve infection and addiction outcomes. Providing attentive, patient-centered care, using a harm reduction approach can facilitate engagement of this marginalized population with the healthcare system.
登录
查看更多内容
DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
在马萨诸塞州发生抗歧视定居之前和之后，拒绝接受阿片类药物使用障碍患者。
影响因子：
5.5
作者：
Kimmel SD;Rosenmoss S;Bearnot B;Larochelle M;Walley AY
通讯作者：
Walley AY
影响因子：
11.8
作者：
Rosenthal, Elana S.;Silk, Rachel;Kattakuzhy, Sarah
通讯作者：
Kattakuzhy, Sarah
影响因子：
4.2
作者：
Barocas JA;Gai MJ;Amuchi B;Jawa R;Linas BP
通讯作者：
Linas BP
影响因子：
6.4
作者：
Marks, Laura R.;Munigala, Satish;Durkin, Michael J.
通讯作者：
Durkin, Michael J.