A Community Care Model of Intravenous Antibiotic Therapy for Injection Drug Users with Deep Tissue Infection for “Reduce Leaving Against Medical Advice”

Abstract

Deep tissue infection is a serious sequela that often demands intravenous (IV) antibiotic treatment. With respect to IV drug users (IDU’s), research and lived experience demonstrates a trend of failed treatment outcomes, most notably associated with leaving hospital against medical advice (LAMA) prior to treatment completion, increased adverse outcomes and patient hardship. This paper examines an alternative model for delivering and completing IV antibiotic treatment to IDU’s in a community care setting. A retrospective study was designed to review client characteristics. A total of 33 in-depth interviews were conducted with clients, clinicians and with staff. The impact of treatment adherence and completion, as well as client satisfaction of care was explored. A total of 165 patients were admitted during the study period. Osteomyelitis was the primary cause for IV antibiotics. Risk of leaving AMA was significantly lower for community model (p value <0.0000). Qualitative narrative analysis is also described with respect to satisfaction, stigma and the need for better models of care. With lower rates of LAMA a community model ought to be considered on a wider scale for provision of comprehensive support for populations with complex underlying health needs.

Outpatient Parenteral Antimicrobial Therapy Among People Who Inject Drugs: A Review of the Literature

“…Two studies [ 11 , 12 ] were prospective studies without any comparison groups, and all others were retrospective. Six were conducted in the United States [ 13–18 ], 2 in Canada [ 11 , 19 ], 1 in Australia [ 20 ], and 1 in Singapore [ 12 ]. The 10 studies included a total of 800 individuals with discreet OPAT episodes.…”

“…Most studies primarily focused on individuals with a recent history of injection drug use (IDU), defined as IDU within the past 4 weeks [ 14 , 18 ], past 3 months [ 13 , 20 ], or past 12 months [ 12 , 15 ]. Other studies indicated that the participants were engaging in current IDU or had a history of IDU [ 16 , 17 , 19 ]. The injected substances were specified as heroin [ 12 , 15 , 16 , 19 ], prescription opioids [ 16 ], cocaine [ 15 , 16 , 19 ], methamphetamine [ 15 , 19 ] and benzodiazepines [ 12 ].…”

“…Other studies indicated that the participants were engaging in current IDU or had a history of IDU [ 16 , 17 , 19 ]. The injected substances were specified as heroin [ 12 , 15 , 16 , 19 ], prescription opioids [ 16 ], cocaine [ 15 , 16 , 19 ], methamphetamine [ 15 , 19 ] and benzodiazepines [ 12 ]. However, the studies did not report any other details of the participants’ substance use or psychiatric history.…”

Treatment of opioid use disorder in an innovative community-based setting after multiple treatment attempts in a woman with untreated HIV

“…The CTCT is a community-based care model that was designed primarily as an alternative to hospital-based treatment for administering long-term intravenous antibiotic treatment in a home-like residential care setting for individuals in Vancouver's Downtown Eastside, a postindustrial neighbourhood with an established drug market and widespread illicit drug use, poverty, poor housing conditions and infectious diseases such as HIV and hepatitis C 13 51. The CTCT employs a harm reduction approach so that patients are able to continue using drugs without fear of retribution or dismissal from the health facility, as is often the case in hospital environments 50.…”

“…The patient was referred to the Community Transitional Care Team (CTCT), an innovative, harm reduction based community clinical support residence for individuals in Vancouver's Downtown Eastside who require long-term intravenous antibiotic therapy, or stabilisation of acute or chronic health issues 13. Patients have access to drug treatment programmes; however, admission to the CTCT is not dependent on drug abstinence or committing to treatment aimed at drug use cessation.…”