"You're Always Jumping Through Hoops": Journey Mapping the Care Experiences of Individuals With Opioid Use Disorder-associated Endocarditis
"You're Always Jumping Through Hoops": Journey Mapping the Care Experiences of Individuals With Opioid Use Disorder-associated Endocarditis
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DOI：
10.1097/adm.0000000000000648
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发表时间：
2020-12-01
影响因子：
5.5
通讯作者：
Mitton, Julian A.
中科院分区：
文献类型：
--
作者：
Bearnot, Benjamin;Mitton, Julian A.
目的：阿片类药物使用障碍(OUD)的严重感染性并发症，特别是心内膜炎，在美国正变得越来越常见。乌德相关性心内膜炎患者需要长期复杂的医疗护理，经常面临反复上瘾和感染相关的并发症，并具有令人沮丧的临床结果。这项研究的目的是进行旅程图分析，以捕捉UD相关性心内膜炎患者的共同轨迹和护理模式。方法：这是对接受超声心动图相关性心内膜炎护理的个人进行的定性半结构化访谈的分析。采访对象是在马萨诸塞州波士顿的一个单一学术医疗系统接受护理的个人。从住院和门诊环境中招募了10名符合DSM-5至少轻度心内膜炎标准和培养阳性诊断心内膜炎的参与者，他们之前已经完成了心内膜炎相关心内膜炎的治疗。参与者的护理事件的细节被提取并在迭代的旅程映射过程中可视化。然后，使用扎根的理论方法来确定参与者旅程地图中的共同主题和护理模式。结果：常见的护理模式包括早期成瘾治疗和未再住院的早期门诊强化护理，而离开门诊护理和恢复药物使用通常在再次住院前直接进行。参与者经常选择离开护理，并主动重新参与护理。结论：旅程地图是一种新颖的、以患者为中心的方法，可以捕捉经历重大污名的患者群体的护理经验和轨迹，这些患者以意想不到的和支离破碎的方式参与医疗系统。对于OUD相关性心内膜炎患者，我们确定了支持和吸引患者的关键时刻，以防止重新使用药物和再次住院。
Objectives: Serious infectious complications of opioid use disorder (OUD), and specifically endocarditis, are becoming more common in the US. Individuals with OUD-associated endocarditis require long periods of complex medical care, often face recurrent addiction- and infection-related complications, and have dismal clinical outcomes. The objective of this study was to perform journey mapping analysis to capture common trajectories and patterns of care for people with OUD-associated endocarditis. Methods: This was an analysis of qualitative semi-structured interviews of individuals who received care for OUD-associated endocarditis. Interviews were conducted among individuals receiving care at a single academic healthcare system in Boston, Massachusetts. Ten participants meeting DSM-5 criteria for at least mild OUD and a culture-positive diagnosis of endocarditis who had previously completed care for OUD-associated endocarditis were recruited from inpatient and ambulatory settings. Details of participant's care episodes were extracted and visualized in an iterative journey mapping process. A grounded theory approach was then used to identify shared themes and care patterns among participants' journey maps. Results: Common patterns of care included early addiction treatment and intensive outpatient care preceding periods without rehospitalization, while leaving outpatient care and return to drug use often directly preceded rehospitalization. Participants frequently left care by choice and proactively reengaged with care. Conclusions: Journey mapping is a novel, patient-centered approach to capturing the care experiences and trajectories of a patient population experiencing significant stigma, who engage with the healthcare system in unexpected and fragmented ways. For individuals with OUD-associated endocarditis, we identified critical moments to support and engage patients to prevent return to drug use and rehospitalization.