“It makes all the sense in the world”: A qualitative evaluation of patient perspectives on implementation outcomes of a peer-facilitated integrated infectious disease and substance use care model

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy Pub Date : 2025-06-25 DOI:10.1016/j.drugpo.2025.104883

Annice Brown , Sharon M. Kelly , Tracy Agee , Jeffrey Hsu , Nicholas Schweizer , Geetanjali Chander , Larry W. Chang , Sheree Schwartz , Oluwaseun Falade-Nwulia

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引用次数: 0

Abstract

Background

Integration of substance use disorder (SUD) care into infectious disease care settings has potential to address high rates of SUD among people with infectious diseases. An understanding of patient perspectives is crucial to optimizing care integration models.

Methods

RESTORE is a low-threshold infectious disease/SUD care integration model incorporating clinician training and support for SUD care provision and peer support for patient engagement implemented in an outpatient infectious disease clinic in Baltimore, Maryland. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, in-depth interviews were completed with participants currently engaged (n = 10) and disengaged (n = 10) from RESTORE. Using a grounded theory approach, themes were synthesized to evaluate reach, effectiveness, maintenance, acceptability, and appropriateness of RESTORE from patients’ perspectives.

Results

RESTORE participants described a range of experiences and barriers to engaging in SUD treatment prior to RESTORE. Participants' perceptions of effectiveness with RESTORE included observed changes in substance use, mental health, and overall quality of life for many, but not all. Sustained impact of RESTORE engagement on participant outcomes also varied. Acceptability and appropriateness of integrated infectious disease and SUD treatment, RESTORE team care coordination, and peer coaching for self-efficacy in SUD recovery were key mechanisms perceived to impact effectiveness.

Conclusion

A peer-facilitated integrated infectious disease/SUD care model was regarded as acceptable, appropriate, and effective in improving outcomes for patients with SUD accessing infectious disease care. Additional strategies are needed to optimize outcomes across the spectrum of patients with infectious disease and SUD.

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“这在全世界都是有意义的”：对病人对同侪促进的传染病和药物使用综合护理模式实施结果的看法进行定性评价

背景：将物质使用障碍（SUD）护理整合到传染病护理环境中，有可能解决传染病患者中SUD的高发问题。了解患者的观点对于优化护理整合模式至关重要。方法restore是一个低门槛传染病/SUD护理整合模型，该模型在马里兰州巴尔的摩市的一家门诊传染病诊所实施，包括临床医生培训和SUD护理提供支持以及患者参与的同伴支持。在Reach、有效性、采用、实施和维护（RE-AIM）框架的指导下，对目前参与（n = 10）和脱离（n = 10） RESTORE的参与者进行了深度访谈。采用扎根理论方法，综合主题，从患者的角度评估RESTORE的覆盖范围、有效性、维持、可接受性和适当性。结果RESTORE参与者描述了在RESTORE之前进行SUD治疗的一系列经历和障碍。参与者对RESTORE有效性的感知包括观察到的物质使用、心理健康和总体生活质量的变化，但不是全部。RESTORE参与对参与者结果的持续影响也各不相同。感染性疾病和SUD综合治疗的可接受性和适当性、RESTORE团队护理协调以及同伴指导对SUD康复自我效能的影响是影响疗效的关键机制。结论同侪促进的感染性疾病/SUD综合护理模式可接受、适宜且有效地改善感染性疾病患者获得感染性疾病护理的结局。需要额外的策略来优化感染性疾病和SUD患者的预后。

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

International Journal of Drug Policy SUBSTANCE ABUSE-

CiteScore

7.80

自引率

11.40%

发文量

307

审稿时长

62 days

期刊介绍： The International Journal of Drug Policy provides a forum for the dissemination of current research, reviews, debate, and critical analysis on drug use and drug policy in a global context. It seeks to publish material on the social, political, legal, and health contexts of psychoactive substance use, both licit and illicit. The journal is particularly concerned to explore the effects of drug policy and practice on drug-using behaviour and its health and social consequences. It is the policy of the journal to represent a wide range of material on drug-related matters from around the world.