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"We've Learned It's a Medical Illness, Not a Moral Choice": Qualitative Study of the Effects of a Multicomponent Addiction Intervention on Hospital Providers' Attitudes and Experiences.
J Hosp Med. 2018 11 01; 13(11):752-758.JH

Abstract

BACKGROUND

Substance use disorders (SUD) represent a national epidemic with increasing rates of SUD-related hospitalizations. However, most hospitals lack expertise or systems to directly address SUD. Healthcare professionals feel underprepared and commonly hold negative views toward patients with SUD. Little is known about how hospital interventions may affect providers' attitudes and experiences toward patients with SUD.

OBJECTIVE

To explore interprofessional hospital providers' perspectives on how integrating SUD treatment and care systems affect providers' attitudes, beliefs, and experiences.

DESIGN

In-depth semi-structured interviews and focus groups. The study was part of a formative evaluation of the Improving Addiction Care Team (IMPACT), an interprofessional hospital-based addiction medicine service with rapid-access pathways to post-hospital SUD treatment.

SETTING

Single urban academic hospital in Portland, Oregon.

PARTICIPANTS

Multidisciplinary hospital providers.

MEASUREMENTS

We conducted a thematic analysis using an inductive approach at a semantic level.

RESULTS

Before IMPACT, participants felt that hospitalization did not address addiction, leading to untreated withdrawal, patients leaving against medical advice, chaotic care, and staff "moral distress." Participants felt that IMPACT "completely reframes" addiction as a treatable chronic disease, improving patient engagement and communication, and humanizing care. Participants valued post-hospital SUD treatment pathways and felt having systems to address SUD reduced burnout and provided relief. Providers noted that IMPACT had limited ability to address poverty or engage highly ambivalent patients.

CONCLUSIONS

Providers' distress of caring for patients with SUD is not inevitable. Hospital-based SUD interventions can reframe providers' views of addiction and may have significant implications for clinical care and providers' well-being.

Authors+Show Affiliations

Oregon Health & Science University, Portland, Oregon, USA. englandh@ohsu.edu. Central City Concern, Portland, Oregon, USA.Oregon Health & Science University, Portland, Oregon, USA.Oregon Health & Science University, Portland, Oregon, USA.Oregon Health & Science University, Portland, Oregon, USA.Oregon Health & Science University, Portland, Oregon, USA.Oregon Health & Science University, Portland, Oregon, USA. School of Social Work, Portland State University, Portland, Oregon, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29694454

Citation

Englander, Honora, et al. ""We've Learned It's a Medical Illness, Not a Moral Choice": Qualitative Study of the Effects of a Multicomponent Addiction Intervention On Hospital Providers' Attitudes and Experiences." Journal of Hospital Medicine, vol. 13, no. 11, 2018, pp. 752-758.
Englander H, Collins D, Perry SP, et al. "We've Learned It's a Medical Illness, Not a Moral Choice": Qualitative Study of the Effects of a Multicomponent Addiction Intervention on Hospital Providers' Attitudes and Experiences. J Hosp Med. 2018;13(11):752-758.
Englander, H., Collins, D., Perry, S. P., Rabinowitz, M., Phoutrides, E., & Nicolaidis, C. (2018). "We've Learned It's a Medical Illness, Not a Moral Choice": Qualitative Study of the Effects of a Multicomponent Addiction Intervention on Hospital Providers' Attitudes and Experiences. Journal of Hospital Medicine, 13(11), 752-758. https://doi.org/10.12788/jhm.2993
Englander H, et al. "We've Learned It's a Medical Illness, Not a Moral Choice": Qualitative Study of the Effects of a Multicomponent Addiction Intervention On Hospital Providers' Attitudes and Experiences. J Hosp Med. 2018 11 1;13(11):752-758. PubMed PMID: 29694454.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - "We've Learned It's a Medical Illness, Not a Moral Choice": Qualitative Study of the Effects of a Multicomponent Addiction Intervention on Hospital Providers' Attitudes and Experiences. AU - Englander,Honora, AU - Collins,Devin, AU - Perry,Sylvia Peterson, AU - Rabinowitz,Molly, AU - Phoutrides,Elena, AU - Nicolaidis,Christina, Y1 - 2018/04/25/ PY - 2018/4/26/entrez PY - 2018/4/26/pubmed PY - 2019/11/21/medline SP - 752 EP - 758 JF - Journal of hospital medicine JO - J Hosp Med VL - 13 IS - 11 N2 - BACKGROUND: Substance use disorders (SUD) represent a national epidemic with increasing rates of SUD-related hospitalizations. However, most hospitals lack expertise or systems to directly address SUD. Healthcare professionals feel underprepared and commonly hold negative views toward patients with SUD. Little is known about how hospital interventions may affect providers' attitudes and experiences toward patients with SUD. OBJECTIVE: To explore interprofessional hospital providers' perspectives on how integrating SUD treatment and care systems affect providers' attitudes, beliefs, and experiences. DESIGN: In-depth semi-structured interviews and focus groups. The study was part of a formative evaluation of the Improving Addiction Care Team (IMPACT), an interprofessional hospital-based addiction medicine service with rapid-access pathways to post-hospital SUD treatment. SETTING: Single urban academic hospital in Portland, Oregon. PARTICIPANTS: Multidisciplinary hospital providers. MEASUREMENTS: We conducted a thematic analysis using an inductive approach at a semantic level. RESULTS: Before IMPACT, participants felt that hospitalization did not address addiction, leading to untreated withdrawal, patients leaving against medical advice, chaotic care, and staff "moral distress." Participants felt that IMPACT "completely reframes" addiction as a treatable chronic disease, improving patient engagement and communication, and humanizing care. Participants valued post-hospital SUD treatment pathways and felt having systems to address SUD reduced burnout and provided relief. Providers noted that IMPACT had limited ability to address poverty or engage highly ambivalent patients. CONCLUSIONS: Providers' distress of caring for patients with SUD is not inevitable. Hospital-based SUD interventions can reframe providers' views of addiction and may have significant implications for clinical care and providers' well-being. SN - 1553-5606 UR - https://www.unboundmedicine.com/medline/citation/29694454/"We've_Learned_It's_a_Medical_Illness_Not_a_Moral_Choice":_Qualitative_Study_of_the_Effects_of_a_Multicomponent_Addiction_Intervention_on_Hospital_Providers'_Attitudes_and_Experiences_ DB - PRIME DP - Unbound Medicine ER -