Format

Send to

Choose Destination
J Subst Abuse Treat. 2019 Jul;102:16-22. doi: 10.1016/j.jsat.2019.04.008. Epub 2019 Apr 23.

Experiences of care among individuals with opioid use disorder-associated endocarditis and their healthcare providers: Results from a qualitative study.

Author information

1
Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America. Electronic address: bbearnot@partners.org.
2
Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
3
Harvard Medical School, Boston, MA, United States of America.
4
Harvard Medical School, Boston, MA, United States of America; Mongan Center for Health Policy, United States of America.

Abstract

PURPOSE:

Infectious complications of opioid use disorder (OUD), including endocarditis, are rising. Patients with OUD-associated endocarditis have poor clinical outcomes but their care is not well understood. We aimed to elucidate the prior experiences of care for patients with OUD-associated endocarditis and the healthcare providers who deliver that care.

STUDY DESIGN:

This qualitative study was conducted through semi-structured interviews of patients and providers at a single academic hospital using a grounded theory approach. Patients meeting DSM-5 criteria for at least mild OUD who had previously completed an episode of care for OUD-associated endocarditis were recruited from inpatient and ambulatory settings. Multidisciplinary care providers who regularly care for patients with OUD-associated endocarditis were also recruited. Interviews were conducted until thematic saturation was achieved.

PRINCIPLE RESULTS:

Of 11 patient participants, six were recruited from outpatient settings. Of 12 provider participants, seven cared for patients with OUD "almost always." Five major themes emerged across patient and provider interviews: stigma-related inequity and delays in care, the social and medical comorbidities of individuals with OUD-associated endocarditis, addiction as a chronic and relapsing disease, differing experiences of prolonged hospitalizations between patients and providers, and a lack of integration or discontinuity of care. Opportunities for care innovation and improvement were identified.

CONCLUSIONS:

This qualitative analysis highlights multiple patient and health system factors that may explain poor clinical outcomes experienced by individuals with OUD-associated endocarditis. A sick, complex, stigmatized patient population was noted, with new physical and mental comorbidities often developing on top of pre-existing ones. Perceived barriers to effective treatment of OUD-associated endocarditis included the complexity of managing two life threatening illness simultaneously, external stigma towards individuals with OUD, and discontinuity in longitudinal care.

KEYWORDS:

Bacterial endocarditis; Disparities in care; Endocarditis; Infective endocarditis; Injection drug use; Intravenous drug use; Opioid use disorder; Prolonged hospitalizations; Stigma

PMID:
31202284
DOI:
10.1016/j.jsat.2019.04.008

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center