Evidence Synthesis and Tables

Article Number

Author and Date

Evidence Type

Sample, Sample Size, Setting

Findings That Help Answer the EBP Question

Observable Measures

Limitations

Evidence Level, Quality

DOI: 10.1007/s11606-016-3919-4 ©

Velez, C. M., Nicolaidis, C., Korthuis, P. T., & Englander, H. (2017). “It’s been an experience, a life learning experience”: a qualitative study of hospitalized patients with substance use disorders. Journal of general internal medicine, 32(3), 296-303.

doi: 10.1007/s11606-016-3919-4

J Gen Intern Med. 2017 Mar; 32(3): 296–303.

Published online 2016 Dec 12.

Qualitative evidence for building knowledge

There were 32 participants who reported high to moderate use of alcohol (39%), amphetamine (46%), and opioids (65%).

The study was conducted in an urban medical Center.

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Addiction is a common issue in society and hospitalization of addicts is a wake up for call. Hospitalization provides an opportunity to initiate coordinated care for addicts (Velez et al., 2017). Most of the victims attribute their addiction to homelessness, pain, trauma, and other social chaos. The participants revealed that they prefer healthcare providers who understood SUD and initiate the best treatment options that support change and enhance patient outcomes. From the interviews, effective strategies include involving peers in the treatment process, coordinated care after patient discharge, and access to medical-assisted intervention strategies (Velez et al., 2017).

The themes that emerged from the analysis are categorized into three factors: patient level factors, provider level factors and health-system factors.

Patient-Level Factors

The first finding is that hospitalization of addicts is a wake-up call because some of them regret putting themselves in situation that makes them end up in hospitals. As most patients narrated, they wish they would never end up in the same situation again. Another revelation is that hospitalization is also an opportunity to stop taking drugs. The patients also reveals that pain complicates care and influences them to take drugs more to manage the pain.

Provider-level factors

The patients identified factors that may affect providers’ approach to care for the addicts. The first one is that care is more effective if the patient has a choice and takes part in decision-making. Patients also revealed that having health providers who are not judgmental encourages them to stay in hospital. For example, care givers who are ex addicts are more understanding, flexible and are likely to influence change. The participants openly mentioned that withdrawal is not easy and effective withdrawal management strategies would be helpful in the process. Treated withdrawal is necessary to prevent suffering and a feeling that the care was inadequate.

Health-system factors

The patients identified the health system as a great influence in care and management of addicts. They identified that hospitals do not offer basic needs such as jackets which makes the lives of addicts more miserable. They also mentioned that health systems fail to address the issues of trauma and stressors, since most of the people around them are hostile. They also emphasized the need of having peers with first-hand experience to take them through the journey. Lastly, they were interested in medication-assisted therapy which they believed was effective.

In my opinion, the patient-factors are the most relevant and plays a greater role in addressing the problem. The system and provider factors are secondary elements can only be incorporated when the patient factors are implemented. For example, providers can only be effective if the patients have identified the need to change. Similarly, effective withdrawal strategies can be impactful if addicts are willing and ready to withdraw.

Interview questions that targeted observations, thoughts experiences, and opinions were used to collect data from the participants.

The first limitation is that the study may lack generalizability because the interview was conducted in a single site and all the patients/participants were insured.

Since the interviews were conducted in a hospital for real-time information, the interviews may have been limited in a way. Real time interviewing may not allow deeper conversations hence limiting respondents from revealing useful information.

The study assesses patient perspectives only, leaving out the perspectives of significant stakeholders such as health care providers and health administrators. This implies that useful inputs that may be incorporated will be left out.

There is influence of personal biases from respondents.

Since interviews are less anonymous, they may be a concern for respondents who may conceal useful information.

Good quality evidence.

Level II.1

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