Patient perspectives on the provision of a needle and syringe program at a large, urban acute care hospital

• Author / Creator

  Brooks, Hannah

• Background: People who inject drugs (PWID) are at increased risk of negative health outcomes and hospitalization. Healthcare providers often struggle to appropriately manage the pain and withdrawal symptoms of PWID. PWID have described experiencing judgment and stigma from healthcare providers and also poorly managed pain and withdrawal symptoms. While hospitalized, PWID may participate in unsafe drug injection practices that place them at risk of harm and negative repercussions from staff. Needle and syringe programs (NSPs) have been shown to reduce harms for PWID in the community, yet their reach into acute care settings is currently limited. Almost no research has examined the provision of inpatient NSP for PWID. The Addiction Recovery and Community Health (ARCH) team at the Royal Alexandra Hospital (RAH) provides patients access to an acute care NSP. The present study was designed to elicit patients’ perspectives on the ARCH team’s novel inpatient NSP. The overall objective was to generate new insights on the acute care experiences of PWID and inpatient NSPs, and generate information useful for informing the ARCH team’s and RAH’s ongoing quality improvement activities.

  Method: A patient-oriented research framework guided decisions made within the study. I adopted a focused ethnographic design used to study patients’ perspectives and experiences. Semi-structured interviews were conducted between April 20, 2017 and January 26, 2018 with 21 inpatients who inject drugs and were under the care of the ARCH team. All interviews were conducted at the hospital, using a semi-structured interview guide that aimed to understand patients’ perspectives of the RAH, the care they received, and also their perspectives of the NSP and how they felt the NSP could be improved. Interviews were recorded and transcribed verbatim. Content analysis was used for data analysis.

  Results: Amongst 21 PWID interviewed, 10 were male and 16 reported accessing the inpatient NSP. Participants ranged in age from 30 to 60. Patients described both positive and negative experiences; however, a significant number of patients reported feeling judged by some members of the hospital staff. Seventeen of the patients interviewed reported injecting while hospitalized. These patients appreciated that the ARCH team provided them sterile injection supplies and felt the NSP helped reduce unsafe injection practices and also made their hospital stay less stressful. They interpreted the presence of the NSP as a sign that the ARCH team was primarily concerned with their health and wellbeing rather than their abstinence from drugs and that the team respected their autonomy. However, some patients interpreted the NSP as a trick and feared or were unaware of how accepting supplies would affect their stay. Some reported being confused about whether they were allowed to use the supplies on hospital grounds. These patients thought hospital staff might treat them in a negative manner and prematurely discharge them, or change aspects of their medication regimes if they accepted supplies. Several patients also felt the ARCH team should work to increase patient awareness of the NSP.

  Discussion and Conclusion: Patients described a variety of experiences and perspectives of the hospital, unit and ARCH staff, and the NSP. Patients stated that the NSP provided them several benefits. The findings of the present study suggest the need for three main modifications to the NSP, including: a) ARCH staff should clarify how accepting supplies might affect a patients’ experience at the RAH (i.e. changes to their medication regimes); b) increase awareness of the NSP by distributing pamphlets in community resource centres; and c) provide patients with a safe environment within the hospital to inject drugs and access supplies. Patients’ experiences also implied or indicated a need for other types of harm reduction interventions beyond the SCS, a culture change within the hospital to reduce real or perceived stigma experienced by PWID, and improvements in how patients are informed regarding aspects of their medication regimes.

• Subjects / Keywords

  • patient oriented research
  • harm reduction
  • acute care
  • injection drug use
  • focused ethnography
  • needle and syringe program

• Graduation date

  Fall 2018

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/R3988336X

• License

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