Post-Opioid Overdose Response Team Intervention Barriers and Facilitators to Substance Use Treatment: Perspectives of Patients and Team Members.

IF 2.1 3区 医学 Q2 EMERGENCY MEDICINE
Rebecca J McCloskey, Alexander J Ulintz, Gretchen Clark Hammond, Jennifer L Brown, Matthew Parrish, Isaac Toliver
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引用次数: 0

Abstract

Objectives: Emergency medical services (EMS) frequently respond to patients with opioid-related overdoses but often lack the infrastructure and capacity to provide resources and support to individuals who decline transportation to the emergency department. Post-overdose response teams pair EMS clinicians with other first responders or substance use treatment professionals to provide outreach, harm reduction materials, and recovery resources. We aimed to explore the experiences of post-overdose patients and team members to better inform a prehospital care intervention and outcomes for patients with opioid use disorder.

Methods: This exploratory case study was part of a larger program evaluation of the Rapid Response Emergency and Addiction Crisis Team (RREACT) and describes the barriers and facilitators to accessing substance use recovery resources from the perspective of former patients (n = 8, called program alumni) and RREACT team members (n = 19) in Columbus, OH, USA. Semi-structured interviews were conducted between October 2019 and August 2020. We used inductive thematic analysis to identify key themes by participant group. Themes were compared for similarities and differences. Member checking with team members, peer debriefing, and triangulation of data were used to increase the trustworthiness of the findings.

Results: Four overall themes were identified: fear, relationships, resources, and stigma. For program alumni, the fear of withdrawal symptoms was categorized as a barrier to treatment, while the fear of death was a facilitator. Positive relationships between alumni and RREACT team members, among team members, and between RREACT and the community facilitated treatment entry. Additional facilitators of the RREACT intervention were resources in terms of their immediate response and ability to navigate systems. Barriers to RREACT's work included substance use stigma, a lack of appropriate and available treatment services, services only accepting particular insurers, and treatment services for special populations.

Conclusions: An EMS-led post-overdose response team provided recovery resources and linkage to treatment by meeting patients in times of desperation, employing non-judgmental personnel, and removing complex barriers. These findings are important to leveraging EMS in expanded roles as part of the larger public health response to opioid overdose.

阿片类药物过量后反应团队干预障碍和促进物质使用治疗:患者和团队成员的观点。
目标:紧急医疗服务(EMS)经常应对与阿片类药物有关的过量患者,但往往缺乏基础设施和能力,无法为拒绝被送往急诊室的个人提供资源和支持。过量反应小组将EMS临床医生与其他急救人员或药物使用治疗专业人员配对,提供外展、减少伤害的材料和恢复资源。我们的目的是探讨过量服用后患者和团队成员的经验,以更好地为阿片类药物使用障碍患者的院前护理干预和结果提供信息。方法:本探索性案例研究是快速反应紧急事件和成瘾危机小组(RREACT)更大项目评估的一部分,从美国俄亥俄州哥伦布市的前患者(n = 8,称为项目校友)和RREACT团队成员(n = 19)的角度描述了获取物质使用恢复资源的障碍和促进因素。半结构化访谈于2019年10月至2020年8月期间进行。我们采用归纳主题分析法,根据参与者群体确定关键主题。比较主题的异同。团队成员之间的相互检查、同行汇报和数据三角测量被用来增加调查结果的可信度。结果:确定了四个总体主题:恐惧,关系,资源和耻辱。对于项目的校友来说,对戒断症状的恐惧被归类为治疗的障碍,而对死亡的恐惧则是一种促进因素。校友与RREACT团队成员之间、团队成员之间以及RREACT与社区之间的积极关系促进了治疗的进入。RREACT干预的其他促进因素是其即时反应和导航系统能力方面的资源。RREACT工作的障碍包括物质使用耻辱,缺乏适当和可用的治疗服务,只接受特定保险公司的服务,以及为特殊人群提供治疗服务。结论:以ems为主导的药物过量后反应小组通过在患者绝望时与患者会面,雇用非评判性人员,消除复杂的障碍,提供了恢复资源和与治疗的联系。这些发现对于扩大EMS的作用,将其作为应对阿片类药物过量的更大公共卫生对策的一部分具有重要意义。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Prehospital Emergency Care
Prehospital Emergency Care 医学-公共卫生、环境卫生与职业卫生
CiteScore
4.30
自引率
12.50%
发文量
137
审稿时长
1 months
期刊介绍: Prehospital Emergency Care publishes peer-reviewed information relevant to the practice, educational advancement, and investigation of prehospital emergency care, including the following types of articles: Special Contributions - Original Articles - Education and Practice - Preliminary Reports - Case Conferences - Position Papers - Collective Reviews - Editorials - Letters to the Editor - Media Reviews.
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