Oral Papers: Addiction, Pain, & Transplant II
Background: In an era of controversy over buzzwords and the cost vs. value of satisfaction questionnaires, a few facts remain refreshingly clear. Infective endocarditis (IE) rates are rising. The proportion of IE patients with intravenous drug use (IVDU) is rising. Discharges against medical advice in IVDU is high. Patient participation in treatment decision-making improves quality of care, increases healthy behaviors and lowers costs. Further, the addictions literature points to the therapeutic alliance as a reliable predictor of retention in addiction treatment.
The literature is also clear that treating patients with substance-use disorders impacts providers in many ways including fear of deception by the patient, uncertainty about treatment options or modalities, and result in avoidant behaviors . This stigmatization potentially stands in the way of patient engagement and formation of a therapeutic alliance.
The literature has a paucity of data on subjective patient experience, and level of engagement in IE and IVDU. 50% of IE patients admitted to our tertiary-care institution over a 6-month period had IVDU.
We describe a qualitative study of patient perspectives on degree of engagement in care during this discreet hospitalization.
Methods: Study subjects will be recruited from a cohort of 51 patients with IVDU and IE admitted during a 6 month period in 2018. After obtaining consent, subjects will be administered a revised Helping Alliance Questionnaire which is a 19 item questionnaire utilizing 6 point Likert scale to gauge the strength of treatment alliance. Subjects will then participate in a semi-structured interview about their hospitalization experience. Questions will focus on the degree to which they felt: they were involved in decision-making by the treatment team, clinical concerns were addressed, physical and other withdrawal symptoms were addressed, they were invested in continuing medical treatment after discharge.
Data on demographics, medical and psychiatric diagnoses, clinical course, participation in care, premature discharge, readmission, and outpatient adherence to recommendations will be collected through retrospective chart review.
Please note: IRB approval for this minimal risk study is in review.
Results: Results are pending
Discussion/Conclusion: We will discuss our results in light of the literature on patient and provider perspectives on therapeutic alliance, engagement, outcomes and treatment retention of patients with IVDU and serious medical illness.
We will discuss the strengths and limitations of the study including the possibility of bias secondary to outcomes of care since that index admission.
We posit that fundamental tenets of patient engagement proven in substance use treatment may well improve outcomes in IE. We discuss future directions including a second phase of this study.
Meier, P.S., Barrowclough, C. and Donmall, M.C. (2005) The role of the therapeutic alliance in the treatment of substance misuse: a critical review of the literature. Addiction, 100 (3), 304-316.