Patient perspectives on a harm reduction-oriented addiction medicine consultation team implemented in a large acute care hospital
Patient perspectives on a harm reduction-oriented addiction medicine consultation team implemented in a large acute care hospital
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DOI：
10.1016/j.drugalcdep.2019.06.025
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发表时间：
2019-11-01
影响因子：
4.2
通讯作者：
Salvalaggio, Ginetta
中科院分区：
文献类型：
--
作者：
Hyshka, Elaine;Morris, Heather;Salvalaggio, Ginetta
背景资料：成瘾药物咨询小组[AMCTs]是改善物质使用障碍患者医院护理的一种有前途的策略。然而，很少有研究探讨AMCT在急性护理环境中的实施。为了解决这一差距，我们进行了一个新的危害减少为导向的AMCT的过程评价。我们的具体目标包括检查患者的观点，促进或阻碍AMCT交付的因素，其对医院护理和outcome.Methods的影响：AMCT提供了综合成瘾医学，减少伤害的服务，和概括性的健康和社会支持的一个大型，城市急性护理医院在加拿大西部的患者。我们采用了一个集中的人种学设计，并招募了21名患者到半结构化的采访中，他们收到的护理team.Results的意见：参与者强调了AMCT的减少伤害的方法;同行之间的声誉;和专门的培训，特别是重要的干预促进者。限制该团队影响的主要障碍包括未满足的期望;难以获得后续护理; AMCT的减少伤害方法与一些医院工作人员的禁欲取向之间的残余冲突。对一些参与者来说，这些冲突导致了负面的经历。尽管如此，与会者报告说，AMCT有积极的影响，包括物质使用的下降，增强心理和情感健康，并改善社会经济环境。结论：一种新的伤害减少为导向的AMCT导致更好的医院的经验和感知结果的患者。然而，还需要进一步努力，以确保充分的出院后随访，并在所有医院工作人员中采取一致的药物使用障碍护理方法。
Background: Addiction medicine consultation teams [AMCTs] are a promising strategy for improving hospital care for patients with substance use disorders. Yet very little research has examined AMCT implementation in acute care settings. To address this gap, we conducted a process evaluation of a novel harm reduction-oriented AMCT. Our specific aims included examining patients' perspectives on factors that facilitated or hindered AMCT delivery, and its impact on their hospital care and outcomes.Methods: The AMCT provided integrated addiction medicine, harm reduction services, and wraparound health and social supports for patients of a large, urban acute care hospital in Western Canada. We adopted a focused ethnographic design and recruited 21 patients into semi-structured interviews eliciting their views on the care they received from the team.Results: Participants highlighted the AMCT's harm reduction approach; reputation amongst peers; and specialized training as especially important intervention facilitators. Key barriers that constrained the impact of the team included unmet expectations; difficulty accessing follow-up care; and residual conflicts between the AMCT's harm reduction approach and the abstinence-only orientation of some hospital staff. For a few participants these conflicts led to negative experiences. Despite this, participants reported that the AMCT had positive impacts overall, including declines in substance use, enhanced mental and emotional wellbeing, and improved socio-economic circumstances.Conclusions: A novel harm reduction-oriented AMCT led to better hospital experiences and perceived outcomes for patients. However, further efforts are needed to ensure adequate post-discharge follow-up, and a consistent approach to substance use disorder care amongst all hospital staff.