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Experiences of stigma in hospitals with addiction consultation services: A qualitative analysis of patients' and hospital-based providers' perspectives.
J Subst Abuse Treat. 2022 07; 138:108708.JS

Abstract

BACKGROUND

Addiction consultation services (ACS) provide evidence-based treatment to hospitalized patients with substance use disorders (SUD). Expansion of hospital-based addiction care may help to counteract the stigma that patients with SUD experience within the health care system. Stigma is among the most impactful barriers to seeking care and adhering to medical advice among people with SUD. We aimed to understand how the presence of an ACS affected patients' and hospital-based providers' experiences with stigma in the hospital setting.

METHODS

We conducted a qualitative study utilizing focus groups and key informant interviews with hospital-based providers (hospitalists and hospital-based nurses, social workers, pharmacists). We also conducted key informant interviews with patients who received care from an ACS during their hospitalization. An interprofessional team coded and analyzed transcripts using a thematic analysis approach to identify emergent themes.

RESULTS

Sixty-two hospital-based providers participated in six focus groups or eight interviews. Twenty patients participated in interviews. Four themes emerged relating to the experiences of stigma reported by hospital-based providers and hospitalized patients with SUD: (1) past experiences in the health care system propagate a cycle of stigmatization between hospital-based providers and patients; (2) documentation in medical charts unintentionally or intentionally perpetuates enacted stigma among hospital-based providers resulting in anticipated stigma among patients; (3) the presence of an ACS reduces enacted stigma among hospital-based providers through expanding the use of evidenced-based SUD treatment and reframing the SUD narrative; (4) ACS team members combat the effects of internalized stigma by promoting feelings of self-worth, self-efficacy, and mutual respect among patients with SUD.

CONCLUSIONS

An ACS can facilitate destigmatization of hospitalized patients with SUD by incorporating evidence-based SUD treatment into routine hospital care, by providing and modeling compassionate care, and by reframing addiction as a chronic condition to be treated alongside other medical conditions. Future reductions of stigma in hospital settings may result from promoting greater use of evidence-based treatment for SUD and expanded education for health care providers on the use of non-stigmatizing language and medical terminology when documenting SUD in the medical chart.

Authors+Show Affiliations

Clinical Science Graduate Program, University of Colorado, Aurora, CO, USA. Electronic address: kaitlyn.hoover@cuanschutz.edu.Adult and Child Consortium for Health Outcomes Research and Delivery Service, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.Division of Hospital Medicine, University of Colorado, Aurora, CO, USA.Department of Family Medicine, University of Colorado, Aurora, CO, USA.Division of Hospital Medicine, University of Colorado, Aurora, CO, USA; Division of General Internal Medicine, University of Colorado, Aurora, CO, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

34991950

Citation

Hoover, Kaitlyn, et al. "Experiences of Stigma in Hospitals With Addiction Consultation Services: a Qualitative Analysis of Patients' and Hospital-based Providers' Perspectives." Journal of Substance Abuse Treatment, vol. 138, 2022, p. 108708.
Hoover K, Lockhart S, Callister C, et al. Experiences of stigma in hospitals with addiction consultation services: A qualitative analysis of patients' and hospital-based providers' perspectives. J Subst Abuse Treat. 2022;138:108708.
Hoover, K., Lockhart, S., Callister, C., Holtrop, J. S., & Calcaterra, S. L. (2022). Experiences of stigma in hospitals with addiction consultation services: A qualitative analysis of patients' and hospital-based providers' perspectives. Journal of Substance Abuse Treatment, 138, 108708. https://doi.org/10.1016/j.jsat.2021.108708
Hoover K, et al. Experiences of Stigma in Hospitals With Addiction Consultation Services: a Qualitative Analysis of Patients' and Hospital-based Providers' Perspectives. J Subst Abuse Treat. 2022;138:108708. PubMed PMID: 34991950.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Experiences of stigma in hospitals with addiction consultation services: A qualitative analysis of patients' and hospital-based providers' perspectives. AU - Hoover,Kaitlyn, AU - Lockhart,Steve, AU - Callister,Catherine, AU - Holtrop,Jodi Summers, AU - Calcaterra,Susan L, Y1 - 2021/12/27/ PY - 2021/08/20/received PY - 2021/11/08/revised PY - 2021/12/14/accepted PY - 2023/07/01/pmc-release PY - 2022/1/8/pubmed PY - 2022/6/7/medline PY - 2022/1/7/entrez KW - Addiction KW - Addiction consultation service KW - Stigma KW - Substance use disorder SP - 108708 EP - 108708 JF - Journal of substance abuse treatment JO - J Subst Abuse Treat VL - 138 N2 - BACKGROUND: Addiction consultation services (ACS) provide evidence-based treatment to hospitalized patients with substance use disorders (SUD). Expansion of hospital-based addiction care may help to counteract the stigma that patients with SUD experience within the health care system. Stigma is among the most impactful barriers to seeking care and adhering to medical advice among people with SUD. We aimed to understand how the presence of an ACS affected patients' and hospital-based providers' experiences with stigma in the hospital setting. METHODS: We conducted a qualitative study utilizing focus groups and key informant interviews with hospital-based providers (hospitalists and hospital-based nurses, social workers, pharmacists). We also conducted key informant interviews with patients who received care from an ACS during their hospitalization. An interprofessional team coded and analyzed transcripts using a thematic analysis approach to identify emergent themes. RESULTS: Sixty-two hospital-based providers participated in six focus groups or eight interviews. Twenty patients participated in interviews. Four themes emerged relating to the experiences of stigma reported by hospital-based providers and hospitalized patients with SUD: (1) past experiences in the health care system propagate a cycle of stigmatization between hospital-based providers and patients; (2) documentation in medical charts unintentionally or intentionally perpetuates enacted stigma among hospital-based providers resulting in anticipated stigma among patients; (3) the presence of an ACS reduces enacted stigma among hospital-based providers through expanding the use of evidenced-based SUD treatment and reframing the SUD narrative; (4) ACS team members combat the effects of internalized stigma by promoting feelings of self-worth, self-efficacy, and mutual respect among patients with SUD. CONCLUSIONS: An ACS can facilitate destigmatization of hospitalized patients with SUD by incorporating evidence-based SUD treatment into routine hospital care, by providing and modeling compassionate care, and by reframing addiction as a chronic condition to be treated alongside other medical conditions. Future reductions of stigma in hospital settings may result from promoting greater use of evidence-based treatment for SUD and expanded education for health care providers on the use of non-stigmatizing language and medical terminology when documenting SUD in the medical chart. SN - 1873-6483 UR - https://www.unboundmedicine.com/medline/citation/34991950/Experiences_of_stigma_in_hospitals_with_addiction_consultation_services:_A_qualitative_analysis_of_patients'_and_hospital_based_providers'_perspectives_ DB - PRIME DP - Unbound Medicine ER -