Surgeons’ Perspectives on Valve Surgery in People With Drug Use-Associated Infective Endocarditis

Wurcel, Alysse G.; Zubiago, Julia; Reyes, Jessica Wolpaw; Smyth, Emma; Balsara, Keki R.; Avila, Danielle; Barocas, Joshua A.; Beckwith, Curt G.; Bui, Jenny; Chastain, Cody A.; Eaton, Ellen; Kimmel, Simeon D; Paras, Molly L; Schranz, Asher J; Vyas, Darshali A; Rapoport, Alison B

doi:10.1016/j.athoracsur.2021.12.068

Cited by 9 publications

(6 citation statements)

References 29 publications

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“…Our work adds to a growing body of qualitative research among PWID and clinicians [ 18 , 19 , 42 , 43 ]. Studies among PWID have identified common patterns of care, including early addiction treatment and intensive outpatient care leading to periods without rehospitalization, whereas individuals who left outpatient care and resumed drug use were more likely to be rehospitalized [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…With some exceptions [ 18 , 19 ], research has focused mostly on perspectives of PWID about PICCs [ 20–22 ]. The goal of this study is to analyze perspectives of not only the patient, but other key stakeholders—doctors, social workers, floor nurses, and PICC nurses—to get a better appraisal of barriers and facilitators to providing safe, quality, evidence-guided antibiotics to PWID.…”

mentioning

confidence: 99%

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“They Just Assume That We’re All Going to Do the Wrong Thing With It. It’s Just Not True”: Stakeholder Perspectives About Peripherally Inserted Central Catheters in People Who Inject Drugs

Morales

Smyth

Zubiago

et al. 2022

Open Forum Infectious Diseases

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Background In the absence of adequate harm reduction opportunities, people who inject drugs (PWID) are at increased risk for serious infections. Infectious diseases guidelines recommend extended periods of intravenous antibiotic treatment through peripherally inserted central catheters (PICCs), but PWID are often deemed unsuitable for this treatment. We conducted semi-structured interviews and focus groups to understand the perspectives and opinions of patients and clinicians on the use of PICCs for PWID. Methods We approached patients and clinicians (doctors, nurses, PICC nurses, social workers, and case workers) involved in patient care at Tufts Medical Center (Boston, Massachusetts) between August 2019 and April 2020 for semi-structured interviews and focus groups. Results Eleven of 14 (79%) patients agreed to participate in an in-depth interview, and 5 role-specific clinician focus groups (1 group consisting of infectious diseases, internal medicine, and addiction psychiatry doctors, 2 separate groups of floor nurses, 1 group of PICC nurses, and 1 group of social workers) were completed. Emergent themes included the overall agreement that PICCs improve healthcare, patients’ feelings that their stage of recovery from addiction was not taken into consideration, and clinicians’ anecdotal negative experiences driving decisions on PICCs. Conclusions When analyzed together, the experiences of PWID and clinicians shed light on ways the healthcare system can improve the quality of care for PWID hospitalized for infections. Further research is needed to develop a system of person-centered care for PWID that meets the specific needs of patients and improves the relationship between them and the healthcare system.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“They Just Assume That We’re All Going to Do the Wrong Thing With It. It’s Just Not True”: Stakeholder Perspectives About Peripherally Inserted Central Catheters in People Who Inject Drugs

Morales

Smyth

Zubiago

et al. 2022

Open Forum Infectious Diseases

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“…Cardiothoracic surgeons have identi ed linkage to care, support structures, and treatment of underlying substance use disorders as major factors when considering valve surgery for patients with injection-associated endocarditis; high rates of infection recurrence and limited linkage to care are surgeon-reported reasons to decline to operate on patients with injection-associated endocarditis. (40,41) Given that linkage to care is a major barrier to achieving high-quality care, the integration of harm reduction into clinical care bundled with corresponding implementation strategies would effectively address current challenges and have long-term, positive impacts on patients who use substances. Moreover, access to SSPs, safe injection education, and safe consumption spaces could prevent initial infection and could be utilized to reduce risk of re-infection after surgery.…”

Section: Discussionmentioning

confidence: 99%

Utilizing Implementation Science to Identify Barriers and Facilitators to Implementing Harm Reduction Services in the Veterans Health Administration (VHA)

Harvey

Sliwiński

Flike

et al. 2022

Preprint

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Background: Rising rates of substance use, particularly the use of synthetic opioids, have led to increases in fatal overdoses and injection-associated infections. Harm reduction, including infection prevention via provision of educational interventions and sterile syringes and other supplies, is an approach to minimize risk of severe outcomes. Although harm reduction services (HRS) are highly evidence-based, implementation in most healthcare settings has been limited. The aim of this study was to identify facilitators and barriers to the implementation of HRS to inform strategies for increasing access and facilitating the adoption of a comprehensive bundle of harm reduction resources within the VHA. Methods:Qualitative interviews were conducted using a semi-structured interview guide. Interviews explored how harm reduction is currently understood and implemented by VHA providers and elicited input on perceived facilitators and barriers to implementation. Data were analyzed using a directed content analysis. After barriers and facilitators were identified, they were mapped to relevant implementation strategies using the Consolidated Framework for Implementation Research - Expert Recommendations for Implementing Change (CFIR – ERIC) tool. Results:15 interviews with VHA providers (physicians, social workers, pharmacists, and directors of addiction and mental health services) were conducted across 5 sites. Multiple barriers and few facilitators to the provision of HRS were identified. Existing HRS were thought to be fragmented and dependent on the knowledge, time, and comfort level of individual providers. Participants also highlighted stigma around substance use, limited support, and burdensome regulatory requirements. Existing infrastructure, social programming, and local champions were highlighted as facilitators. Given these factors, implementation strategies that may be bundled to promote adoption of HRS include engagement of champions, communications and educational strategies, existing policies, and creation of dashboards, tracking, and feedback systems. Conclusions: HRS are effective and evidence-based, yet their adoption into traditional healthcare settings has been limited. Mapping of barriers to evidence-based implementation strategies may help improve integration of HRS into VHA healthcare, however, challenges addressing stigma remain a substantial barrier. More research is needed to identify implementation strategies that are most effective for addressing barriers imposed by stigma.

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“…Surgeons have cited concerns related to postoperative pain, medical treatment adherence, completion of antibiotic therapy, and personal emotional burden in making decisions about whether to perform valve surgery. 94 Early involvement of anesthesia, addiction medicine, and intensive care teams for preoperative medication adjustment and planning is important to manage pain effectively and to treat opioid withdrawal, if present, which can worsen acute pain.…”

Section: Indications For Surgery In Pwid With Iementioning

confidence: 99%

Management of Infective Endocarditis in People Who Inject Drugs: A Scientific Statement From the American Heart Association

Baddour¹,

Weimer²,

Wurcel³

et al. 2022

Circulation

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BACKGROUND: The American Heart Association has sponsored both guidelines and scientific statements that address the diagnosis, management, and prevention of infective endocarditis. As a result of the unprecedented and increasing incidence of infective endocarditis cases among people who inject drugs, the American Heart Association sponsored this original scientific statement. It provides a more in-depth focus on the management of infective endocarditis among this unique population than what has been provided in prior American Heart Association infective endocarditis–related documents. METHODS: A writing group was named and consisted of recognized experts in the fields of infectious diseases, cardiology, addiction medicine, and cardiovascular surgery in October 2021. A literature search was conducted in Embase on November 19, 2021, and multiple terms were used, with 1345 English-language articles identified after removal of duplicates. CONCLUSIONS: Management of infective endocarditis in people who inject drugs is complex and requires a unique approach in all aspects of care. Clinicians must appreciate that it requires involvement of a variety of specialists and that consultation by addiction-trained clinicians is as important as that of more traditional members of the endocarditis team to improve infective endocarditis outcomes. Preventive measures are critical in people who inject drugs and are cured of an initial bout of infective endocarditis because they remain at extremely high risk for subsequent bouts of infective endocarditis, regardless of whether injection drug use is continued.

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Surgeons’ Perspectives on Valve Surgery in People With Drug Use-Associated Infective Endocarditis

Cited by 9 publications

References 29 publications

“They Just Assume That We’re All Going to Do the Wrong Thing With It. It’s Just Not True”: Stakeholder Perspectives About Peripherally Inserted Central Catheters in People Who Inject Drugs

“They Just Assume That We’re All Going to Do the Wrong Thing With It. It’s Just Not True”: Stakeholder Perspectives About Peripherally Inserted Central Catheters in People Who Inject Drugs

Utilizing Implementation Science to Identify Barriers and Facilitators to Implementing Harm Reduction Services in the Veterans Health Administration (VHA)

Management of Infective Endocarditis in People Who Inject Drugs: A Scientific Statement From the American Heart Association

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