Advancing patient‐centered care for structurally vulnerable drug‐using populations: a qualitative study of the perspectives of people who use drugs regarding the potential integration of harm reduction interventions into hospitals

Abstract

Aims To explore the perspectives of structurally vulnerable people who use drugs (PWUD) regarding: (1) the potential integration of harm reduction interventions (e.g., supervised drug consumption services, opioid assisted treatment) into hospitals; and, (2) the implications of these interventions for patient-centered care, hospital outcomes, and drug-related risks and harms. Design Semi-structured qualitative interviews. Setting Vancouver, Canada. Participants 30 structurally vulnerable PWUD who had been discharged from hospital against medical advice within the past two years, and hospitalized multiple times over the past five years. Measurements Semi-structured interview guide including questions to elicit perspectives on hospital-based harm reduction interventions. Findings Participant accounts highlighted that hospital-based harm reduction interventions would promote patient-centered care by: (1) prioritizing hospital care access and risk reduction over the enforcement of abstinence-based drug policies; (2) increasing responsiveness to subjective health needs (e.g., pain and withdrawal symptoms); and, (3) fostering ‘culturally safe’ care. Conclusions Hospital-based harm reduction interventions for people who use drugs, such as supervised drug consumption services and opioid assisted treatment, can potentially improve hospital care retention, promote patient-centred care, and reduce adverse health outcomes among people who use drugs.

How competent are people who use opioids at responding to overdoses? Qualitative analyses of actions and decisions taken during overdose emergencies

“…the provision of rescue opioids in the event of naloxone over-antagonism or rapid access to opioid assisted treatment) might increase post-overdose hospital attendance and retention, promote patient-centred care and ultimately reduce adverse health outcomes [37,63]. Notably, two participants successfully administered naloxone contrary to professional advice and another took drugs to a hospitalized victim, because hospital staff would not provide methadone to ease his withdrawals until the following day.…”

“…Furthermore, hospital-based harm reduction interventions that acknowledge the subjective health needs and experiences of people who use drugs (e.g. the provision of rescue opioids in the event of naloxone over-antagonism or rapid access to opioid assisted treatment) might increase post-overdose hospital attendance and retention, promote patient-centred care and ultimately reduce adverse health outcomes [37,63].…”

Uso de reducción de daños y gravedad psicopatológica y médica en pacientes en programa de mantenimiento con metadona

“…En estudios previos ya se menciona el hecho de que los pacientes REDAN en general se encuentran en un período más grave de la adicción (McNeil, Kerr, Pauly, Wood y Small, 2016). Además en la muestra de menores de 45 años se detectan diferencias tanto en la subescala de drogas como en la familiar, lo que apuntaría a menor soporte social en pacientes PMM-REDAN (Jhanjee, Lal, Mondal y Jain, 2011).…”

Uptake into a bedside needle and syringe program for acute care inpatients who inject drugs

“…Studies indicate that NSPs are associated with significant public health benefits, including a reduction in syringe sharing and other risk behaviours, and reduced risk of HIV . Yet to date, NSP access has been largely limited to community settings, and no research has examined their implementation in hospitals .…”