Implementation of an integrated infectious disease and substance use disorder team for injection drug use-associated infections: a qualitative study

Abstract

Background Hospitalizations for severe injection drug use-related infections (SIRIs) are characterized by high costs, frequent patient-directed discharge, and high readmission rates. Beyond the health system impacts, these admissions can be traumatizing to people who inject drugs (PWID), who often receive inadequate treatment for their substance use disorders (SUD). The Jackson SIRI team was developed as an integrated infectious disease/SUD treatment intervention for patients hospitalized at a public safety-net hospital in Miami, Florida in 2020. We conducted a qualitative study to identify patient- and clinician-level perceived implementation barriers and facilitators to the SIRI team intervention. Methods Participants were patients with history of SIRIs (n = 7) and healthcare clinicians (n = 8) at one implementing hospital (Jackson Memorial Hospital). Semi-structured qualitative interviews were performed with a guide created using the Consolidated Framework for Implementation Research (CFIR). Interviews were transcribed, double coded, and categorized by study team members using CFIR constructs. Results Implementation barriers to the SIRI team intervention identified by participants included: (1) complexity of the SIRI team intervention; (2) lack of resources for PWID experiencing homelessness, financial insecurity, and uninsured status; (3) clinician-level stigma and lack of knowledge around addiction and medications for opioid use disorder (OUD); and (4) concerns about underinvestment in the intervention. Implementation facilitators of the intervention included: (1) a non-judgmental, harm reduction-oriented approach; (2) the team’s advocacy for PWID as a means of institutional culture change; (3) provision of close post-hospital follow-up that is often inaccessible for PWID; (4) strong communication with patients and their hospital physicians; and (5) addressing diverse needs such as housing, insurance, and psychological wellbeing. Conclusion Integration of infectious disease and SUD treatment is a promising approach to managing patients with SIRIs. Implementation success depends on institutional buy-in, holistic care beyond the medical domain, and an ethos rooted in harm reduction across multilevel (inner and outer) implementation contexts.

Impact of integrated treatment of hepatitis C on happiness among people who inject drugs: results from the INTRO-HCV.

“…A qualitative study examining an integrated infectious diseases/SUD treatment program showed that even if HCV was cured, this did not seem to affect the wellbeing of patients. 30 One possible explanation might be that HCV infection can be asymptomatic for many years and some patients will even progress through life without ever developing symptoms. 12,18 For those patients without severe symptoms, not perceiving substantial changes in health might not affect their level of happiness.…”

Opportunities to improve opioid use disorder care for hospitalised patients with endocarditis

“…In line with this, hospitals have proposed a collaborative care model incorporating addiction specialists emphasising a short-term follow-up and planning for outpatient continuation 28. This intervention, however, has its own barriers including clinician stigma and lack of knowledge around evidence-based addiction treatment as well as a lack of resources for the intervention 29…”

“… 28 This intervention, however, has its own barriers including clinician stigma and lack of knowledge around evidence-based addiction treatment as well as a lack of resources for the intervention. 29 …”

“…28 This intervention, however, has its own barriers including clinician stigma and lack of knowledge around evidence-based addiction treatment as well as a lack of resources for the intervention. 29 Several study limitations should be mentioned. Participants who chose to participate were more likely to be interested in providing care for OUD-IE, which may present selection bias.…”