title: A Community Care Model of Intravenous Antibiotic Therapy for Injection Drug Users with Deep Tissue Infection for "Reduce Leaving Against Medical Advice"
abstract: Deep tissue infection is a serious sequela that often demands intravenous (IV) antibiotic treatment. With respect to IV drug users (IDU's), research and lived experience demonstrates a trend of failed treatment outcomes, most notably associated with leaving hospital against medical advice (LAMA) prior to treatment completion, increased adverse outcomes and patient hardship. This paper examines an alternative model for delivering and completing IV antibiotic treatment to IDU's in a community care setting. A retrospective study was designed to review client characteristics. A total of 33 in-depth interviews were conducted with clients, clinicians and with staff. The impact of treatment adherence and completion, as well as client satisfaction of care was explored. A total of 165 patients were admitted during the study period. Osteomyelitis was the primary cause for IV antibiotics. Risk of leaving AMA was significantly lower for community model (p value <0.0000). Qualitative narrative analysis is also described with respect to satisfaction, stigma and the need for better models of care. With lower rates of LAMA a community model ought to be considered on a wider scale for provision of comprehensive support for populations with complex underlying health needs.
authors: Addiction Medicine Program, Vancouver Coastal Health Authority, Vancouver, BC Canada.
authors: Siavash
authors: S
authors: Jafari
authors: Addiction Medicine Program, Vancouver Coastal Health Authority, Vancouver, BC Canada.
authors: Ronald
authors: R
authors: Joe
authors: Department of Social Sciences, York University, 4700 Keele Street, Toronto, ON M3J 1P3 Canada.
authors: Danielle
authors: D
authors: Elliot
authors: Addiction Medicine Program, Vancouver Coastal Health Authority, Vancouver, BC Canada.
authors: Ashnoor
authors: A
authors: Nagji
authors: Addiction Medicine Program, Vancouver Coastal Health Authority, Vancouver, BC Canada.
authors: Sargent
authors: S
authors: Hayden
authors: Community Engagement, Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, ON P3E 2C6 Canada.
authors: David C
authors: DC
authors: Marsh
keywords: Antibiotic therapy; Deep tissue infection; Drug users; LAMA; Leaving against medical advice