“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

Abstract

Background 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. Methods 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. Results 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. Conclusions 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.

Implementation of a bundle to improve HIV testing during hospitalization for people who inject drugs

“…PAs, representing surgical and medical subspecialties, felt that HIV was outside of the scope of subspecialty care. Hospitalization is a critical opportunity for testing and linkage to care, as many PWID are frequently reluctant to seek outpatient medical care due to significant barriers, including stigma and concerns about receiving substandard medical care ( Dion et al, 2020 ; Motavalli et al, 2021 ; Paquette et al, 2018 ). Many of the inpatient providers’ main hesitation toward the PWID bundle was the potential for loss to follow-up and not completing the hepatitis A virus or hepatitis B virus vaccination series.…”

“…Hospitalized patients with substance use disorder were recruited for 45-min semistructured, in-depth interviews on ways to improve their healthcare, including their perspectives on antibiotics and experiences of inpatient HIV screening. An analysis of the themes related to PWID care has been published (Morales et al, 2022). Inclusion criteria included self-reported injection drug use within the past year.…”

“I know my body better than anyone else”: a qualitative study of perspectives of people with lived experience on antimicrobial treatment decisions for injection drug use-associated infections

“…13 However, PWID are often not offered this treatment option due to concerns regarding the use of a central venous catheter to inject drugs. 12,14 By offering medications for the index infection and opioid use disorder, care management, and counseling follow-up, patients who leave with "nontraditional" outpatient treatment can achieve favorable health outcomes. 10 Though many healthcare professionals (HCPs) are open to discussing these options with patients, there are some who are concerned that patients will not complete antibiotic courses after discharge, increasing the risk for antimicrobial resistance, infectious complications, and hospital readmission.…”

“…Furthermore, many patients believe that they were not offered outpatient options due to stigma from their care team. 14 We sought to better understand the perspectives of people with lived experience of IDU on engaging patients with IDU-associated infections on decisions about antimicrobial treatment options, including outpatient options. We interviewed hospitalized PWID and community partnerswho work directly with PWID -to identify what they believe is relevant for considering long-term hospitalization, outpatient treatments, and including PWID in treatment decisions.…”

“… 13 However, PWID are often not offered this treatment option due to concerns regarding the use of a central venous catheter to inject drugs. 12 , 14 …”