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Type of submission: Oral
Conference track: Research
Topics: Creating Enabling Environments; Key Populations and Harm Reduction
Presenting author: Adrian Guta
Adrian Guta, Carol Strike, Soo Chan Carusone, Ross Upshur, Curtis Cooper, Darrell Tan, Karen de Prinse
Background: Many people living with HIV/AIDS (PHAs) use illicit and prescription drugs in a non-medically indicated manner, and drink hazardously, for a range of reasons. Substance use by PHAs is associated with higher rates of emergency room visits, poor health outcomes, and repeat hospital admissions. In hospital, PHAs who use substances often encounter stigma, receive substandard care, and are more likely to leave against medical advice. This qualitative study explores the health care provider perspective about what leads to discharges against medical advice (DAMA) for PHAs.
Methods: Twenty-six health care providers (11 physicians, 6 nurses, 4 social workers, 4 pharmacists, and 1 dietician) were recruited from three Toronto and Ottawa hospitals. Data were collected through semi-structured interviews which were audio-recorded and transcribed verbatim. An inductive approach was used to analyze the data.
Results: Participants conceptualized DAMA as part of a longer process that can begin at the time of admission (or a previous admission) and is influenced by a range of interpersonal, organizational and structural factors. In particular, participants identified the following factors that contribute to DAMA among substance using PHAs: poor pain and withdrawal symptom management; conflict between providers and patients about treatment plans, procedures, behaviours and attitudes; patient boredom and frustration; and patients deciding they feel well enough to leave. Participants had mixed feelings about their level of responsibility for patients leaving. However, many described strategies they use when they anticipate PHAs may leave, including having pharmacy prescriptions ready, following up with primary or community care providers, and under extreme circumstances engaging security or law enforcement to retrieve patients.
Conclusion: Our study advances the limited research on DAMA among PHAs who use substances by identifying important factors beyond the patient which need to be considered. This abstract is part of a special session about harm reduction in hospitals.