Table 5.
“What Strategies Have You Found Particularly Helpful to Providing Comprehensive Medical Management to PWID?” Example Comments by Theme, the Infectious Diseases Society of America Emerging Infections Network, 2017
| Using Inpatient and Outpatient Programs |
| “Best in my experience is when hospital/system can provide dedicated specialist to help patient with substance abuse while inpatient and then link to outpatient services.” “Nothing short of prolonged inpatient treatment followed by very attentive outpatient follow up from dedicated addiction specialists.” “Using the severe infection as a tool to help the person address underlying issues, and linking the person with in hospital and out of hospital supports.” |
| Linking or Referring to Addiction Services and Mental Health |
| “All hospitals should have a 12-step program (NA or AA) available for patients and community members in need.” “Our outpatient clinic now has a buprenorphine clinic which is excellent but having greater services inpatient would be of great import.” “Buprenorphine providers affiliated with the medical center with easy follow-up with and multiple spots available.” “Getting them referred to a long-term inpatient setting that includes substance abuse treatment and counseling.” “Assessment via addiction medicine specialist to help determine likelihood of relapsing at discharge.” |
| Working With Multidisciplinary Team |
| “Working w/ a multidisciplinary team on trying to come up with treatment plans and shared expectations for patients with ongoing IV drug use that are going to be admitted for long term.” “Multi-disciplinary approach so it is not solely my responsibility to decide if patient is safe for home OPAT therapy.” “Creation of a separate multidisciplinary team that focuses on inpatient PWID with infection requiring IV.” “Team approach works best...specialization in addiction medicine...also for the patient getting multiple perspectives and REINFORCEMENT of the message to come clean.” |
| Provider–Patient Relationship |
| “A strong personal relationship and appealing to patient’s self-interest.” “Explicit discussion about concerns regarding active IVDU and effect on plan of care.” “Don’t blame the user. Instead offer support until they become hopeful enough to make a successful quit attempt.” “Taking a nonjudgmental approach to interaction with patients appears to lead to more open communication.” |
| Engaging Family/Support System (Utilize Social/Community Services) |
| “Engage patients support system if available to assist in care and help in bridge to rehab program.” “Early social work and family involvement.” “Social services along with hospital and community services need to join in helping drug addiction.” “Working with community-based partners (i.e. needle exchange and MMT) where people are already receiving services.” “Inpatient order sets for patients with SUDs (includes STI screening, narcan prescribing), staff education/teaching lectures, leadership support, capacity building with community organizations.” “Community/peer navigators, outreach workers.” |
| Challenges |
| “Very limited resources, we usually keep in house for 2–3 weeks then try to D/C on PO. No real rehab available, limited chronic pain management.” “The health system will cover hundreds of thousands of dollars for medical management of infectious complications then not cover any rehab.” “Substance abuse treatment is well beyond the scope of ID trained physician.” “Need more healthcare resources to focus on this issue.” “I see no concerted effort from either government or individual hospital systems to deal with this problem.” |
Abbreviations: AA, Alcoholics Anonymous; D/C, discharge; ID, infectious diseases; IV, intravenous; IVDU, intravenous drug use; MMT, methadone maintenance treatment; NA, Narcotics Anonymous; PO, per oral; OPAT, outpatient parenteral antibiotic therapy; PWID, people who inject drugs; STI, sexually transmitted infection; SUD, substance use disorder.