"They Just Assume That We're All Going to Do the Wrong Thing With It. It's Just Not True": Stakeholder Perspectives About Peripherally Inserted Central Catheters in People Who Inject Drugs.
"They Just Assume That We're All Going to Do the Wrong Thing With It. It's Just Not True": Stakeholder Perspectives About Peripherally Inserted Central Catheters in People Who Inject Drugs.
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DOI：
10.1093/ofid/ofac364
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发表时间：
2022-10
影响因子：
4.2
通讯作者：
中科院分区：
文献类型：
--
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在缺乏足够的减少危害机会的情况下，注射毒品者（PWID）遭受严重感染的风险增加。传染病指南建议通过外周插入中心导管（PICC）进行长期静脉抗生素治疗，但PWID通常被认为不适合这种治疗。我们进行了半结构化访谈和焦点小组，以了解患者和临床医生对使用PICC治疗PWID的观点和意见。我们接触了2019年8月至2020年4月期间在塔夫茨医疗中心（马萨诸塞州波士顿）参与患者护理的患者和临床医生（医生，护士，PICC护士，社会工作者和个案工作者），进行半结构化访谈和焦点小组。14例患者中有11例（79%）同意参加深入访谈，并完成了5个特定角色的临床医生焦点组（1组由传染病，内科和成瘾精神病学医生组成，2个独立的楼层护士组，1组PICC护士和1组社会工作者）。新出现的主题包括PICC改善医疗保健的总体一致性，患者的感觉，他们从成瘾中恢复的阶段没有被考虑在内，以及临床医生的轶事负面经验推动对PICC的决定。当一起分析时，PWID和临床医生的经验揭示了医疗保健系统如何提高因感染住院的PWID的护理质量。需要进一步的研究来开发一个以人为本的PWID护理系统，以满足患者的特定需求，并改善他们与医疗保健系统之间的关系。这项研究的访谈主题包括使用外周插入中心静脉导管（PICC），以改善医疗保健的人谁注射毒品，患者的恐惧，污名影响护理，反思PICC的安全性，和影响的患者导向出院对临床医生的关注。
In the absence of adequate harm reduction opportunities, people who inject drugs (PWID) are at increased risk for serious infections. Infectious diseases guidelines recommend extended periods of intravenous antibiotic treatment through peripherally inserted central catheters (PICCs), but PWID are often deemed unsuitable for this treatment. We conducted semi-structured interviews and focus groups to understand the perspectives and opinions of patients and clinicians on the use of PICCs for PWID. We approached patients and clinicians (doctors, nurses, PICC nurses, social workers, and case workers) involved in patient care at Tufts Medical Center (Boston, Massachusetts) between August 2019 and April 2020 for semi-structured interviews and focus groups. Eleven of 14 (79%) patients agreed to participate in an in-depth interview, and 5 role-specific clinician focus groups (1 group consisting of infectious diseases, internal medicine, and addiction psychiatry doctors, 2 separate groups of floor nurses, 1 group of PICC nurses, and 1 group of social workers) were completed. Emergent themes included the overall agreement that PICCs improve healthcare, patients’ feelings that their stage of recovery from addiction was not taken into consideration, and clinicians’ anecdotal negative experiences driving decisions on PICCs. When analyzed together, the experiences of PWID and clinicians shed light on ways the healthcare system can improve the quality of care for PWID hospitalized for infections. Further research is needed to develop a system of person-centered care for PWID that meets the specific needs of patients and improves the relationship between them and the healthcare system. Interview themes of this study include the use of peripherally inserted central catheters (PICCs) to improve healthcare for people who inject drugs, patients’ fears that stigma affects care, reflections on the safety of PICCs, and the influence of patient-directed discharges on clinicians’ concerns.
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