PDF(Pubmed)
Abstract：
BACKGROUND: Emergency Departments (EDs) have become critical \'touchpoints\' for the identification and early engagement of patients at risk of overdose or who have an opioid use disorder (OUD). Our objectives were to examine patients\' ED experiences, identify barriers and facilitators of service uptake in ED settings, and explore patients\' experiences with ED staff.
METHODS: This qualitative study was part of a randomized controlled trial that evaluated the effectiveness of clinical social workers and certified peer recovery specialists in increasing treatment uptake and reducing opioid overdose rates for people with OUD. Between September 2019 and March 2020, semi-structured interviews were conducted 19 participants from the trial. Interviews sought to assess participants\' ED care experiences across intervention type (i.e., clinical social worker or peer recovery specialist). Participants were purposively sampled across intervention arm (social work, n = 11; peer recovery specialist, n = 7; control, n = 1). Data were analyzed thematically with a focus on participant experiences in the ED and social and structural factors shaping care experiences and service utilization.
RESULTS: Participants reported varied ED experiences, including instances of discrimination and stigma due to their substance use. However, participants underscored the need for increased engagement of people with lived experience in ED settings, including the use of peer recovery specialists. Participants highlighted that ED provider interactions were critical drivers of shaping care and service utilization and needed to be improved across EDs to improve post-overdose care.
CONCLUSIONS: While the ED provides an opportunity to reach patients at risk of overdose, our results demonstrate how ED-based interactions and service provision can impact ED care engagement and service utilization. Modifications to care delivery may improve experiences for patients with OUD or at high risk for overdose.
BACKGROUND: Clinical trial registration: NCT03684681.
METHODS: This qualitative study was part of a randomized controlled trial that evaluated the effectiveness of clinical social workers and certified peer recovery specialists in increasing treatment uptake and reducing opioid overdose rates for people with OUD. Between September 2019 and March 2020, semi-structured interviews were conducted 19 participants from the trial. Interviews sought to assess participants\' ED care experiences across intervention type (i.e., clinical social worker or peer recovery specialist). Participants were purposively sampled across intervention arm (social work, n = 11; peer recovery specialist, n = 7; control, n = 1). Data were analyzed thematically with a focus on participant experiences in the ED and social and structural factors shaping care experiences and service utilization.
RESULTS: Participants reported varied ED experiences, including instances of discrimination and stigma due to their substance use. However, participants underscored the need for increased engagement of people with lived experience in ED settings, including the use of peer recovery specialists. Participants highlighted that ED provider interactions were critical drivers of shaping care and service utilization and needed to be improved across EDs to improve post-overdose care.
CONCLUSIONS: While the ED provides an opportunity to reach patients at risk of overdose, our results demonstrate how ED-based interactions and service provision can impact ED care engagement and service utilization. Modifications to care delivery may improve experiences for patients with OUD or at high risk for overdose.
BACKGROUND: Clinical trial registration: NCT03684681.
摘要：
背景：急诊科（ED）已成为识别和早期参与存在用药过量风险或阿片类药物使用障碍（OUD）的患者的关键“接触点”。我们的目标是检查患者的ED经历，确定ED设置中服务吸收的障碍和促进者，并探索患者与ED工作人员的经验。
方法：这项定性研究是一项随机对照试验的一部分，该试验评估了临床社会工作者和经过认证的同伴康复专家在增加OUD患者的治疗剂量和降低阿片类药物过量发生率方面的有效性。在2019年9月至2020年3月期间，对19名试验参与者进行了半结构化访谈。访谈旨在评估参与者跨干预类型的ED护理体验(即，临床社会工作者或同伴康复专家)。参与者有目的地在干预部门(社会工作，n=11；同行恢复专家，n=7；控制，n=1)。对数据进行了主题分析，重点是ED中的参与者体验以及影响护理体验和服务利用的社会和结构因素。
结果：参与者报告了不同的ED经历，包括因使用药物而受到歧视和羞辱的情况。然而,参与者强调需要增加在ED环境中有生活经验的人的参与，包括使用同行恢复专家。参与者强调，ED提供者的互动是塑造护理和服务利用的关键驱动因素，需要在ED中进行改进，以改善用药过量后的护理。
结论：虽然ED为有用药过量风险的患者提供了一个机会，我们的结果证明了基于ED的互动和服务提供如何影响ED护理投入和服务利用率.对护理交付的修改可能会改善OUD患者或过量服用高风险患者的体验。
背景：临床试验注册：NCT03684681。
方法：这项定性研究是一项随机对照试验的一部分，该试验评估了临床社会工作者和经过认证的同伴康复专家在增加OUD患者的治疗剂量和降低阿片类药物过量发生率方面的有效性。在2019年9月至2020年3月期间，对19名试验参与者进行了半结构化访谈。访谈旨在评估参与者跨干预类型的ED护理体验(即，临床社会工作者或同伴康复专家)。参与者有目的地在干预部门(社会工作，n=11；同行恢复专家，n=7；控制，n=1)。对数据进行了主题分析，重点是ED中的参与者体验以及影响护理体验和服务利用的社会和结构因素。
结果：参与者报告了不同的ED经历，包括因使用药物而受到歧视和羞辱的情况。然而,参与者强调需要增加在ED环境中有生活经验的人的参与，包括使用同行恢复专家。参与者强调，ED提供者的互动是塑造护理和服务利用的关键驱动因素，需要在ED中进行改进，以改善用药过量后的护理。
结论：虽然ED为有用药过量风险的患者提供了一个机会，我们的结果证明了基于ED的互动和服务提供如何影响ED护理投入和服务利用率.对护理交付的修改可能会改善OUD患者或过量服用高风险患者的体验。
背景：临床试验注册：NCT03684681。
