Experiences of stigma in hospitals with addiction consultation services: A qualitative analysis of patients' and hospital-based providers' perspectives

Hoover, Kaitlyn; Lockhart, Steve; Callister, Catherine; Holtrop, Jodi Summers; Calcaterra, Susan L.

doi:10.1016/j.jsat.2021.108708

Cited by 38 publications

(35 citation statements)

References 50 publications

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“…Addiction consults were significantly associated with increased odds of planned discharge [odds ratio (OR) 1.36] and with MOUD initiation and linkage to outpatient care, despite only being completed 44% of the time. This is consistent with prior studies that have described the positive impact of addiction consult services on MOUD receipt, premature discharge and readmission [14][15][16][17] as well as stigma [18]. Not surprisingly, if a patient continued or newly initiated MOUD, odds of a planned discharge were even higher (OR 3.87 and 4.85, respectively).…”

supporting

confidence: 90%

Source control: treating opioid use disorder among inpatients with related infections, an urgent call to action

McCrary,

Solomon

2023

Aids

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supporting

confidence: 90%

Source control: treating opioid use disorder among inpatients with related infections, an urgent call to action

McCrary,

Solomon

2023

Aids

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“… 24 , 25 Repeated negative experiences with healthcare can leave individuals hesitant to seek treatment over fears of manipulation and prejudiced behavior, delaying vital care. 26 However, there has been much less effort and progress made to decrease this associated stigma when compared to the efforts behind the reduction of stigma associated with HIV and mental health. 24 …”

Section: Discussionmentioning

confidence: 99%

Relentless Stigma: A Qualitative Analysis of a Substance Use Recovery Needs Assessment

et al. 2022

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Substance use disorders (SUD) pose emotional, mental, and physical threats to persons worldwide. There is a paucity of research focused on capturing individual perspectives on supports and barriers to recovery from a SUD. This need has been identified in areas of Minnesota where a gap in evidence-based substance use support exists. A team of interdisciplinary professionals distributed a qualitative survey assessing supports and barriers to SUD recovery within recovery circles in order to inform the efforts of local organizations. This paper and online access survey was adapted from an existing survey created by Faces and Voices of Recovery. The online survey was accessed by a link and distributed to persons in recovery across Minnesota over 7 months. Data from this survey were analyzed through a consensual qualitative research (CQR) coding method. Notable themes emerged in the following domains: healthcare, environment, individual, and community. Community-wide stigma was an overarching concern, and the study yielded unique insights into stigma within healthcare and the community at-large. Barriers and support to recovery were reported. Barriers included experiencing high levels of stigma and identifying a need for community education on SUDs and recovery. Support included local recovery groups, peer recovery support, and access to healthcare and medication. Our findings illuminate the needs of the recovery community from the perspective of individuals with lived experience and will inform local organizations in specifying resources to help meet the identified needs. This survey may also be adapted and used around the world to inform substance use prevention, treatment, and recovery programing.

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“…The primary clinical outcome was all-cause, 30-day hospital readmission rate, assessed through EHR query that detects admissions to at least 34 other hospitals in the state (as of the start of the trial). This outcome was selected because: (1) it is highly relevant to clinicians [ 30 ], policymakers [ 31 ], and patients who often experience disease-related stigma in hospital settings [ 32 , 33 ], and (2) it is not dependent on patient follow-up or recall, thus ensuring near-complete data collection among this inherently unstable population.…”

Section: Methodsmentioning

confidence: 99%

Single-dose intravenous ketamine or intramuscular naltrexone for high-utilization inpatients with alcohol use disorder: pilot trial feasibility and readmission rates

Terasaki

Loh

Cornell

et al. 2022

Addict Sci Clin Pract

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Background Alcohol use disorder (AUD) accounts for millions of acute care encounters annually in the United States. Hospitalization represents a vital opportunity to intervene pharmacologically, but low medication adherence is a significant barrier. Two single-dose, adherence-independent interventions are well suited for pre-discharge administration: intravenous (IV) ketamine and intramuscular (IM) naltrexone. Their feasibility and readmission-reducing efficacy in hospital settings are not well-established. Methods A 3-arm, open-label randomized trial was conducted at our safety-net medical hospital among high-utilization inpatients with severe AUD. Consented adults (age 18–65) were randomized to (1) IV ketamine (KET) 0.5 mg/kg over 40 min, (2) IM naltrexone (NTX) 380 mg once, or (3) linkage alone (LA). The primary clinical outcome was 30-day all-cause hospital readmission rate. All were provided enhanced linkage to outpatient addiction clinic. Results We consented and randomized 44 participants (n = 13, 14, 17 for KET, NTX, LA, respectively), with a mean of 3.2 past-year hospitalizations. Compared to the LA arm, both the KET arm (RR 0.37, p = 0.17) and NTX arm (RR 0.52, p = 0.27) had a lower 30-day readmission rate, though the differences were nonsignificant. Immediate acceptability ratings of KET and NTX were 9.50 and 9.17 out of 10, respectively. No serious adverse events or illicit ketamine use was reported. Conclusions Both interventions are feasible and showed promise in reducing readmissions for high-utilization AUD inpatients. Despite randomization, baseline characteristics may have differed in ways that biased against the control arm. Additional pragmatic studies—with larger sample size, blinding, and robust follow-up data collection—are needed to verify findings and better understand mediating factors. ClinicalTrials.gov Identifier NCT04562779. Registered 24 September 2020. https://clinicaltrials.gov/ct2/show/NCT04562779

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Experiences of stigma in hospitals with addiction consultation services: A qualitative analysis of patients' and hospital-based providers' perspectives

Cited by 38 publications

References 50 publications

Source control: treating opioid use disorder among inpatients with related infections, an urgent call to action

Source control: treating opioid use disorder among inpatients with related infections, an urgent call to action

Relentless Stigma: A Qualitative Analysis of a Substance Use Recovery Needs Assessment

Single-dose intravenous ketamine or intramuscular naltrexone for high-utilization inpatients with alcohol use disorder: pilot trial feasibility and readmission rates

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