A qualitative assessment of discharge against medical advice among patients hospitalized for injection-related bacterial infections in West Virginia.
AMA discharge
Endocarditis
Injection drug use
People who inject drugs
Journal
The International journal on drug policy
ISSN: 1873-4758
Titre abrégé: Int J Drug Policy
Pays: Netherlands
ID NLM: 9014759
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
received:
13
08
2020
revised:
04
03
2021
accepted:
05
03
2021
pubmed:
26
3
2021
medline:
14
9
2021
entrez:
25
3
2021
Statut:
ppublish
Résumé
The incidence of infective endocarditis (IE) and other systemic bacterial infections is increasing, and people who inject drugs (PWID) have higher rates of discharge against medical advice (AMA) for these infections than patients whose infections are not injection-related. In this study, we characterize factors that contribute to AMA hospital discharge among PWID. We conducted qualitative interviews with twenty PWID hospitalized with serious injection-related bacterial infections in West Virginia. Participants completed a brief survey and in-depth qualitative interview. Interviews were recorded and transcribed verbatim and analyzed using a codebook developed based on deductive and inductive thematic analysis. We also conducted medical records abstraction and used descriptive statistics to summarize medical and survey data. Average age was 34 years, 55% were female, 95% identified as white, and 75% had a primary diagnosis of IE. Drugs injected prior to hospitalization were methamphetamine (60%), prescription opioids (38%), and/or heroin/fentanyl (25%). Participants cited multiple contributors to AMA discharge including negative interactions with hospital staff that they perceived as stigmatizing, including being searched or monitored for illicit drug use; inadequate management of pain and withdrawal; boredom and confinement during lengthy hospitalizations; and isolation from family and other social supports. We identified multiple factors contributing to AMA discharge that are amenable to intervention. Given the significant morbidity, mortality, and financial costs associated with hospitalizing PWID for serious injection-related bacterial infections, hospitals should be highly motivated to develop and test interventions designed to improve outcomes among these patients.
Sections du résumé
BACKGROUND
The incidence of infective endocarditis (IE) and other systemic bacterial infections is increasing, and people who inject drugs (PWID) have higher rates of discharge against medical advice (AMA) for these infections than patients whose infections are not injection-related. In this study, we characterize factors that contribute to AMA hospital discharge among PWID.
METHODS
We conducted qualitative interviews with twenty PWID hospitalized with serious injection-related bacterial infections in West Virginia. Participants completed a brief survey and in-depth qualitative interview. Interviews were recorded and transcribed verbatim and analyzed using a codebook developed based on deductive and inductive thematic analysis. We also conducted medical records abstraction and used descriptive statistics to summarize medical and survey data.
RESULTS
Average age was 34 years, 55% were female, 95% identified as white, and 75% had a primary diagnosis of IE. Drugs injected prior to hospitalization were methamphetamine (60%), prescription opioids (38%), and/or heroin/fentanyl (25%). Participants cited multiple contributors to AMA discharge including negative interactions with hospital staff that they perceived as stigmatizing, including being searched or monitored for illicit drug use; inadequate management of pain and withdrawal; boredom and confinement during lengthy hospitalizations; and isolation from family and other social supports.
CONCLUSION
We identified multiple factors contributing to AMA discharge that are amenable to intervention. Given the significant morbidity, mortality, and financial costs associated with hospitalizing PWID for serious injection-related bacterial infections, hospitals should be highly motivated to develop and test interventions designed to improve outcomes among these patients.
Identifiants
pubmed: 33765516
pii: S0955-3959(21)00104-3
doi: 10.1016/j.drugpo.2021.103206
pmc: PMC8373672
mid: NIHMS1686464
pii:
doi:
Substances chimiques
Fentanyl
UF599785JZ
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
103206Subventions
Organisme : NIGMS NIH HHS
ID : U54 GM104942
Pays : United States
Informations de copyright
Copyright © 2021 Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declarations of Interest Dr. Haut reports grants from the West Virginia Department of Health and Human Resources, personal fees from Medtronic, and NIDA/NIH grants outside the submitted work; in addition, Dr. Haut has a patent for outcome assessment in substance use disorder pending. The other authors have nothing to disclose.
Références
Intern Med J. 2013 Jul;43(7):798-802
pubmed: 23461391
Semin Thorac Cardiovasc Surg. 2019 Spring;31(1):40-45
pubmed: 30165237
Am J Public Health. 2015 Dec;105(12):e53-9
pubmed: 26469651
PLoS One. 2011;6(9):e24459
pubmed: 21931723
Clin Cardiol. 2019 Apr;42(4):432-437
pubmed: 30802984
J Addict Med. 2021 Apr 1;15(2):155-158
pubmed: 32804690
Clin Infect Dis. 2020 Mar 3;70(6):1226-1229
pubmed: 31342057
J Hosp Med. 2018 Apr 25;13(11):752-758
pubmed: 29694454
Am J Med. 2020 Nov;133(11):1343-1349
pubmed: 32445720
J Community Health. 2018 Jun;43(3):598-603
pubmed: 29305727
Open Forum Infect Dis. 2018 Nov 16;5(12):ofy304
pubmed: 30555849
Am J Med. 2016 May;129(5):481-5
pubmed: 26597670
J Addict Med. 2021 Jan-Feb 01;15(1):49-54
pubmed: 32541363
Gen Hosp Psychiatry. 2019 Mar - Apr;57:44-49
pubmed: 30908961
Drug Alcohol Depend. 2013 Jul 1;131(1-2):23-35
pubmed: 23490450
Int J Drug Policy. 2018 Jul;57:104-110
pubmed: 29715589
J Am Coll Cardiol. 2019 Feb 12;73(5):559-570
pubmed: 30732709
Ann Thorac Surg. 2015 Sep;100(3):875-82
pubmed: 26095108
MMWR Morb Mortal Wkly Rep. 2018 Jan 04;67(5152):1419-1427
pubmed: 30605448
Open Forum Infect Dis. 2018 Aug 07;5(9):ofy194
pubmed: 30211247
Soc Sci Med. 2014 Mar;105:59-66
pubmed: 24508718
Am J Addict. 2020 Mar;29(2):155-159
pubmed: 31930608
BMC Infect Dis. 2018 Oct 24;18(1):532
pubmed: 30355291
J Subst Abuse Treat. 2019 Jul;102:16-22
pubmed: 31202284
PLoS One. 2015 Oct 28;10(10):e0141594
pubmed: 26509447
Clin Infect Dis. 2020 Jul 27;71(3):564-571
pubmed: 31504326
Open Forum Infect Dis. 2016 Jul 26;3(3):ofw157
pubmed: 27800528
J Gen Intern Med. 2017 Mar;32(3):296-303
pubmed: 27957661
Open Forum Infect Dis. 2019 Mar 01;6(4):ofz089
pubmed: 30949535
J Gen Intern Med. 2010 Sep;25(9):926-9
pubmed: 20425146
Pain Manag Nurs. 2014 Mar;15(1):165-75
pubmed: 24602434
Am J Med. 2012 Jun;125(6):594-602
pubmed: 22513194
J Addict Med. 2019 Jan/Feb;13(1):69-74
pubmed: 30252689
Addiction. 2016 Apr;111(4):685-94
pubmed: 26498577
J Acquir Immune Defic Syndr. 2004 Jan 1;35(1):56-9
pubmed: 14707793
CMAJ. 2003 Feb 18;168(4):417-20
pubmed: 12591781
BMC Infect Dis. 2019 Nov 8;19(1):918
pubmed: 31699053