Responding to Illegal Drug Use in Acute Care: Patient Needs and Perspectives

• Author / Creator

  Kosteniuk, Brynn M

• People who use illegal drugs (PWUD) seek acute care at disproportionately higher rates than members of the general population. Presentations to acute care provide an important opportunity to engage with PWUD. However, hospitals are often ill-equipped to meet the needs of this population. PWUD experience high rates of delayed presentations for care, premature discharge, and frequent readmissions as medical and social crises are not adequately addressed during hospitalizations. These indicators of unmet need warrant research and policies that seek to improve acute care for this patient group. The overall goal of my thesis is to identify ways to improve and refine acute care delivery for PWUD, ultimately to promote better patient and hospital outcomes. My thesis includes two studies that addressed this goal. In Study 1 I assessed prevalence of perceived unmet service needs amongst acute care-seeking PWUD, self-reported barriers to care, and the utility of the Behavioral Model for Vulnerable Populations in predicting high levels of unmet service needs for this population. In Study 2 I described the perspectives of hospitalized PWUD regarding reasons for accessing or not accessing a supervised consumption service (SCS) in a large, urban hospital in Western Canada. A patient-oriented approach underpinned both studies, in which patients who use drugs provided first-hand knowledge regarding their service needs. People with lived experience of substance use were also consulted on each study design as well as my interpretations of the data. To conduct Study 1, I analyzed self-report survey data from 285 recently hospitalized PWUD. Using hierarchical setwise logistic regression, I applied the Behavioral Model for Vulnerable Populations by entering predictor variables in blocks. Each block represented a domain of the framework (predisposing, enabling, and need factors). In Study 2 I adopted a focused ethnographic study design and conducted 28 semi-structured interviews with SCS eligible patients to elicit their perspectives on SCS uptake. On average, interviews were one hour long, and I used latent content analysis to examine participant accounts. Findings from Study 1 demonstrate that despite most participants reporting a need for services and receiving services, many had high levels of perceived unmet service needs (46%), with unmet needs for counselling (56%) and social interventions (50%) being most prevalent. Structural barriers to services were more commonly reported than motivational barriers. These findings are similar to those reported in community and population health studies, which may reflect broader healthcare utilization patterns amongst this population. Tailoring acute care delivery to better suit the needs of PWUD may therefore help address the overall service needs of this population more effectively. In my regression analyses, including all three Vulnerable Model domains best explained unmet service needs. Significant predictors of high unmet need included reporting recent criminal activity, adverse childhood experiences, transitory sleeping, lack of a regular community support worker, and depression. Study 2 findings show that participants primarily accessed the SCS to minimize risk of drug-related harms in hospital and to avoid taking drugs in unsafe areas of the facility where they may face sanctions from hospital staff or drug law enforcement. However, fears of formal or informal sanctions and worries about changes to patient care following SCS use (e.g., judgement by staff, changes to medication) deterred uptake for some. Participants also cited limitations to the service’s offerings, namely SCS eligibility requirements and a lack of inhalation services available. Together, these findings suggest that PWUD may be inclined to access SCS in acute care facilities to help address safety needs while using drugs in hospital. However, barriers to access must be addressed to facilitate patient uptake and wider provision of SCS in acute care, which may prove to be difficult without broader federal or provincial drug policy reforms.

• Subjects / Keywords

  • Harm reduction
  • Acute care
  • Hospitals
  • Substance use

• Graduation date

  Fall 2020

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-tne7-1j27

• License

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