Experiences of stigma in hospitals with addiction consultation services: A qualitative analysis of patients' and hospital-based providers' perspectives.
Experiences of stigma in hospitals with addiction consultation services: A qualitative analysis of patients' and hospital-based providers' perspectives.
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DOI：
10.1016/j.jsat.2021.108708
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发表时间：
2022-07
影响因子：
3.9
通讯作者：
Calcaterra, Susan L.
中科院分区：
文献类型：
--
作者：
Hoover, Kaitlyn;Lockhart, Steve;Callister, Catherine;Holtrop, Jodi Summers;Calcaterra, Susan L.
成瘾咨询服务（ACS）为物质使用障碍（SUD）住院患者提供循证治疗。扩大以医院为基础的成瘾护理可能有助于抵消SUD患者在医疗保健系统中经历的耻辱。污名是SUD患者寻求护理和坚持医疗建议的最大障碍之一。我们的目的是了解ACS的存在如何影响患者和医院提供者在医院环境中的耻辱体验。我们进行了一项定性研究，利用焦点小组和关键知情人访谈与医院为基础的供应商（住院医生和医院为基础的护士，社会工作者，药剂师）。我们还对住院期间接受ACS护理的患者进行了关键线人访谈。一个跨专业的团队使用主题分析方法对成绩单进行编码和分析，以确定紧急主题。62个医院为基础的供应商参加了六个焦点小组或八个访谈。20名患者参加了访谈。四个主题出现的经验，以医院为基础的供应商和住院的SUD患者的污名报告：（1）过去的经验，在卫生保健系统传播的耻辱医院为基础的供应商和患者之间的循环;（2）病历无意或有意地延续制定的耻辱在医院为基础的供应商，导致预期的耻辱在患者之间;（3）ACS的存在通过扩大使用循证SUD治疗和重构SUD叙述来减少医院提供者之间的既定耻辱;（4）ACS团队成员通过促进SUD患者的自我价值感，自我效能感和相互尊重来对抗内化耻辱的影响。ACS可以通过将循证SUD治疗纳入常规医院护理，通过提供和模拟同情护理，以及通过将成瘾重新定义为与其他医疗条件一起治疗的慢性疾病，来促进SUD住院患者的污名化。未来减少耻辱在医院设置可能会导致促进更多地使用循证治疗SUD和扩大教育的卫生保健提供者使用非污名化的语言和医学术语时，记录SUD的医疗图表。
Addiction consultation services (ACS) provide evidence-based treatment to hospitalized patients with substance use disorders (SUD). Expansion of hospital-based addiction care may help to counteract the stigma that patients with SUD experience within the health care system. Stigma is among the most impactful barriers to seeking care and adhering to medical advice among people with SUD. We aimed to understand how the presence of an ACS affected patients’ and hospital-based providers’ experiences with stigma in the hospital setting. We conducted a qualitative study utilizing focus groups and key informant interviews with hospital-based providers (hospitalists and hospital-based nurses, social workers, pharmacists). We also conducted key informant interviews with patients who received care from an ACS during their hospitalization. An interprofessional team coded and analyzed transcripts using a thematic analysis approach to identify emergent themes. Sixty-two hospital-based providers participated in six focus groups or eight interviews. Twenty patients participated in interviews. Four themes emerged relating to the experiences of stigma reported by hospital-based providers and hospitalized patients with SUD: (1) past experiences in the health care system propagate a cycle of stigmatization between hospital-based providers and patients; (2) documentation in medical charts unintentionally or intentionally perpetuates enacted stigma among hospital-based providers resulting in anticipated stigma among patients; (3) the presence of an ACS reduces enacted stigma among hospital-based providers through expanding the use of evidenced-based SUD treatment and reframing the SUD narrative; (4) ACS team members combat the effects of internalized stigma by promoting feelings of self-worth, self-efficacy, and mutual respect among patients with SUD. An ACS can facilitate destigmatization of hospitalized patients with SUD by incorporating evidence-based SUD treatment into routine hospital care, by providing and modeling compassionate care, and by reframing addiction as a chronic condition to be treated alongside other medical conditions. Future reductions of stigma in hospital settings may result from promoting greater use of evidence-based treatment for SUD and expanded education for health care providers on the use of non-stigmatizing language and medical terminology when documenting SUD in the medical chart.
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影响因子：
4.4
作者：
Carusone, Soo Chan;Guta, Adrian;Strike, Carol
通讯作者：
Strike, Carol
影响因子：
3.5
作者：
Flanagan, Elizabeth H.;Miller, Rebecca;Davidson, Larry
通讯作者：
Davidson, Larry
影响因子：
5.7
作者：
Goddu, Anna P.;O'Conor, Katie J.;Beach, Mary Catherine
通讯作者：
Beach, Mary Catherine
DOI：
10.2307/3348969
发表时间：
1966-01-01
期刊：
MILBANK MEMORIAL FUND QUARTERLY-HEALTH AND SOCIETY
影响因子：
--
作者：
DONABEDIAN, A
通讯作者：
DONABEDIAN, A
影响因子：
3.9
作者：
Fanucchi, Laura C.;Lofwall, Michelle R.;Walsh, Sharon L.
通讯作者：
Walsh, Sharon L.