Understanding why patients with substance use disorders leave the hospital against medical advice: A qualitative study
Understanding why patients with substance use disorders leave the hospital against medical advice: A qualitative study
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DOI：
10.1080/08897077.2019.1671942
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发表时间：
2019-10-18
期刊：
影响因子：
3.5
通讯作者：
Wakeman, Sarah
中科院分区：
文献类型：
--
作者：
Simon, Rachel;Snow, Rachel;Wakeman, Sarah
背景：违背医嘱出院（AMA）与负面健康结果和再次入院有关。物质使用障碍（SUD）患者出院AMA的可能性是无SUD患者的三倍。研究表明，治疗不足的退出和耻辱感可能会增加风险，然而，迄今为止，还没有发表的定性研究探讨SUD患者过早离开的具体原因。方法：半结构式访谈患者（n？15)在2017年9月至2018年9月期间从我院出院并记录了AMA的SUD患者。采用最大变异抽样来显示性别、种族、年龄和物质使用障碍类型（酒精与阿片类药物）的多样性。患者接受采访，直到没有新的概念出现从额外的采访。两名编码员分别对所有转录本进行编码，并协调代码分配。结果：四个核心问题被确定为患者？过早离开医院的原因：戒断治疗不足和持续渴望使用药物，不受控制的急性和慢性疼痛，医院工作人员对SUD的羞辱和歧视，以及医院限制，包括不允许间歇性离开医院楼层。对于有犯罪史的病人来说，住院让他们想起了被监禁。结论：这些发现阐明了SUD患者出院的原因，AMA是一种与30天死亡率和再次入院增加相关的事件。AMA出院代表了医疗保健系统错过了与SUD患者进行接触的机会。我们的研究结果支持住院成瘾治疗的必要性，特别是对戒断和并发疼痛的管理，以及解决与成瘾相关的医疗保健提供者污名的必要性。
Background: Hospital discharges against medical advice (AMA) is associated with negative health outcomes and re-admissions. Patients with substance use disorders (SUD) are up to three times more likely to be discharged AMA as compared to those without SUD. Studies suggest that undertreated withdrawal and a perception of stigma may increase the risk, however, to date, there are no published qualitative studies exploring the specific reasons why patients with SUD leave prematurely. Methods: Semi-structured interviews with patients (n?=?15) with SUD with documented AMA discharges from our hospital between 9/2017 and 9/2018. Maximum variation sampling was employed to display diversity across gender, race, age, and type of substance use disorder (alcohol vs opioids). Patients were interviewed until no new concepts emerged from additional interviews. Two coders separately coded all transcripts and reconciled code assignments. Results: Four core issues were identified as patients? reasons for leaving the hospital prematurely: undertreated withdrawal and ongoing craving to use drugs, uncontrolled acute and chronic pain, stigma and discrimination by hospital staff about their SUD, and hospital restrictions, including not being allowed to intermittently leave the hospital floor. For patients with histories of criminal involvement, being hospitalized reminded them of being incarcerated. Conclusion: These findings shed light on the reasons patients with SUD are discharged from the hospital AMA, an event that is associated with increased thirty-day mortality and hospital re-admission. AMA discharges represent missed opportunities for the health care system to engage with patients struggling with a SUD. Our findings support the need for inpatient addiction treatment, particularly for management of withdrawal and co-occurring pain, and the need to address health care provider associated stigma surrounding addiction.