Exploring care of hospital inpatients with substance involvement

Kiepek, Niki; Jones-Bonofiglio, Kristen; Freemantle, Stacey; Byerley-Vita, Mandy; Quaid, Kristine

doi:10.1016/j.socscimed.2021.114071

Cited by 7 publications

(5 citation statements)

References 34 publications

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“…Confiscating needles and syringes leads patients to hide and re-use blunted or contaminated injecting equipment, which increases the risk of bacterial infections including IDU-IE among hospitalized patients who inject drugs [5] and may also increase risk for needle-stick injuries among hospital staff [11,53]. Coupled with stigmatizing behaviours such as suspicion, surveillance, and restriction of pain medications, these approaches not only erode therapeutic relationships but are ineffective and can cause patients harm [22,50,[54][55][56][57][58].…”

Section: Plos Onementioning

confidence: 99%

“…Such a setting of mutual mistrust and undertreated pain and opioid withdrawal contributes to high rates of illicit or non-medical substance use in hospital and discharges against medical advice among hospitalized patients who use drugs [22,54,55,[58][59][60]. Hospitals have been conceptualized as high-risk environments for people who use drugs [5,59], as abstinencebased policies and threats of punishment lead to high-risk behaviours like using drugs alone in locked bathrooms, rushing injections and missing veins, and taking a bigger dose than usual to try to make it last longer [58][59][60].…”

Section: Plos Onementioning

confidence: 99%

“…Use of sterile injecting equipment is associated with decreased risk of IDU-IE [17]. Although these practices comprise the standard-ofcare for opioid use disorder [7,18], OAT and sterile injecting equipment are not routinely offered in many hospitals; this represents missed opportunities to reduce risks of death and recurrent infections [8,11,[19][20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

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Unequal access to opioid agonist treatment and sterile injecting equipment among hospitalized patients with injection drug use-associated infective endocarditis

et al. 2022

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Background Addiction treatment and harm reduction services reduce risks of death and re-infection among patients with injection drug use-associated infective endocarditis (IDU-IE), but these are not offered at many hospitals. Among hospitalized patients with IDU-IE at the two tertiary-care hospitals in the Canadian Maritimes, we aimed to identify (1) the availability of opioid agonist treatment (OAT) and sterile drug injecting equipment, and (2) indicators of potential unmet addiction care needs. Methods Retrospective review of IDU-IE hospitalizations at Queen Elizabeth II Health Sciences Centre (Halifax, Nova Scotia) and the Saint John Regional Hospital (Saint John, New Brunswick), October 2015 -March 2017. In Halifax, there are no addiction medicine providers on staff; in Saint John, infectious diseases physicians also practice addiction medicine. Inclusion criteria were: (1) probable or definite IE as defined by the modified Duke criteria; and (2) injection drug use within the prior 3 months. Results We identified 38 hospitalizations (21 in Halifax and 17 in Saint John), for 30 unique patients. Among patients with IDU-IE and untreated opioid use disorder, OAT was offered to 36% (5/14) of patients in Halifax and 100% (6/6) of patients in Saint John. Once it was offered, most patients at both sites initiated OAT and planned to continue it after discharge. In Halifax, no patients were offered sterile injecting equipment, and during five hospitalizations staff confiscated patients’ own equipment. In Saint John, four patients were offered (and one was provided) injecting equipment in hospital, and during two hospitalizations staff confiscated patients’ own equipment. Concerns regarding undertreated pain or opioid withdrawal were documented during 66% (25/38) of hospitalizations, and in-hospital illicit or non-medical drug use during 32% (12/38). Two patients at each site (11%; 4/38) had self-directed discharges against medical advice. Conclusions Patients with IDU-IE in the Canadian Maritimes have unequal access to evidence-based addiction care depending on where they are hospitalized, which differs from the community-based standard of care. Indicators of potential unmet addiction care needs in hospital were common.

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Section: Plos Onementioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Unequal access to opioid agonist treatment and sterile injecting equipment among hospitalized patients with injection drug use-associated infective endocarditis

et al. 2022

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“…The practice of patient and community engagement in research can be advanced if research reports make it transparent, both in plain language reports for communities and papers in scholarly journals. Documenting the lessons learned during the research process in a report for the community is an example of the former, giving a head start to subsequent research projects (e.g., Kiepek et al, 2020). The method section of scholarly papers should describe the patient and community consultations, collaboration, or co-production process, to support replication, evaluation, and improve our research practices.…”

Section: Advancing Meaningful Patient and Community Engagement In Res...mentioning

confidence: 99%

“…La documentation des leçons apprises au cours du processus de recherche dans un rapport à l’intention de la communauté est un exemple de pratique pouvant donner une longueur d’avance à d’autres projets de recherche (voir p. ex. Kiepek et al, 2020). La section sur la méthodologie des articles savants devrait inclure une description du processus de consultation, de collaboration ou de coproduction auprès des patients et de la communauté afin de favoriser la reproduction, l’évaluation et l’amélioration des pratiques de recherche.…”

Section: Promouvoir Un Engagement Significatif Des Patients Et De La ...unclassified

Advancing Patient and Community Engagement in Occupational Therapy Research

Davidson¹,

Martini²

2022

Can J Occup Ther

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Occupational therapy research has a long and varied history of involving patients, public, and communities in research as advisors, collaborators, and co-researchers. In Canada, funding agencies have expected patients and knowledge users to be research team members for more than a decade, as illustrated in initiatives like the Canadian Institutes for Health Research (CIHR) Strategy for Patient-Oriented Research (CIHR, 2019). However, the extent to which researchers engage with patient or community partners and the quality of engagement varies. The three of us writing this editorial (one patient researcher and two academic researchers) bring our own experiences with research teams to discuss why patient and community engagement in research matters. We advocate for wider inclusion of patient and community collaborators in research teams, integrating an explicit description of this engagement in the methods section of research reports, and appropriate recognition of contributions from patient and community collaborators, including authorship.

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