Advancing patient-centered care for structurally vulnerable drug-using populations: a qualitative study of the perspectives of people who use drugs regarding the potential integration of harm reduction interventions into hospitals.
OBJECTIVE
To explore the perspectives of structurally vulnerable people who use drugs (PWUD) regarding: (1) the potential integration of harm reduction interventions (e.g. supervised drug consumption services, opioid-assisted treatment) into hospitals; and (2) the implications of these interventions for patient-centered care, hospital outcomes and drug-related risks and harms.


METHODS
Semi-structured qualitative interviews.


METHODS
Vancouver, Canada.


METHODS
Thirty structurally vulnerable PWUD who had been discharged from hospital against medical advice within the past 2 years, and hospitalized multiple times over the past 5 years.


METHODS
Semi-structured interview guide including questions to elicit perspectives on hospital-based harm reduction interventions.


RESULTS
Participant accounts highlighted that hospital-based harm reduction interventions would promote patient-centered care by: (1) prioritizing hospital care access and risk reduction over the enforcement of abstinence-based drug policies; (2) increasing responsiveness to subjective health needs (e.g. pain and withdrawal symptoms); and (3) fostering 'culturally safe' care.


CONCLUSIONS
Hospital-based harm reduction interventions for people who use drugs, such as supervised drug consumption services and opioid-assisted treatment, can potentially improve hospital care retention, promote patient-centered care and reduce adverse health outcomes among people who use drugs.
BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.|Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
Ryan
R
McNeil
BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.|Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Thomas
T
Kerr
School of Nursing, University of Victoria, Victoria, BC, Canada.|Centre for Addictions Research of British Columbia, Victoria, BC, Canada.
Bernie
B
Pauly
BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.|Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Evan
E
Wood
BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.|Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
Will
W
Small
D000328:Adult; D055030:Drug Users; D005260:Female; D040261:Harm Reduction; D006761:Hospitals; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D018802:Patient-Centered Care / Q000379:methods*; D036301:Qualitative Research; D012306:Risk; D019966:Substance-Related Disorders / Q000628:therapy*; D035862:Vulnerable Populations
Drug users; harm reduction; health services; hospitals; patient-centered care; qualitative