Experiences of care among individuals with opioid use disorder-associated endocarditis and their healthcare providers: Results from a qualitative study.
PURPOSE
Infectious complications of opioid use disorder (OUD), including endocarditis, are rising. Patients with OUD-associated endocarditis have poor clinical outcomes but their care is not well understood. We aimed to elucidate the prior experiences of care for patients with OUD-associated endocarditis and the healthcare providers who deliver that care.


STUDY DESIGN
This qualitative study was conducted through semi-structured interviews of patients and providers at a single academic hospital using a grounded theory approach. Patients meeting DSM-5 criteria for at least mild OUD who had previously completed an episode of care for OUD-associated endocarditis were recruited from inpatient and ambulatory settings. Multidisciplinary care providers who regularly care for patients with OUD-associated endocarditis were also recruited. Interviews were conducted until thematic saturation was achieved.


PRINCIPLE RESULTS
Of 11 patient participants, six were recruited from outpatient settings. Of 12 provider participants, seven cared for patients with OUD "almost always." Five major themes emerged across patient and provider interviews: stigma-related inequity and delays in care, the social and medical comorbidities of individuals with OUD-associated endocarditis, addiction as a chronic and relapsing disease, differing experiences of prolonged hospitalizations between patients and providers, and a lack of integration or discontinuity of care. Opportunities for care innovation and improvement were identified.


CONCLUSIONS
This qualitative analysis highlights multiple patient and health system factors that may explain poor clinical outcomes experienced by individuals with OUD-associated endocarditis. A sick, complex, stigmatized patient population was noted, with new physical and mental comorbidities often developing on top of pre-existing ones. Perceived barriers to effective treatment of OUD-associated endocarditis included the complexity of managing two life threatening illness simultaneously, external stigma towards individuals with OUD, and discontinuity in longitudinal care.
['Bearnot|Benjamin|B|', 'Mitton|Julian A|JA|', 'Hayden|Margaret|M|', 'Park|Elyse R|ER|']
D000328:Adult D003266:Continuity of Patient Care D003695:Delivery of Health Care D004696:Endocarditis D005260:Female D066296:Grounded Theory D006282:Health Personnel D054625:Healthcare Disparities D006760:Hospitalization D006801:Humans D007407:Interviews as Topic D008297:Male D008875:Middle Aged D009293:Opioid-Related Disorders D057545:Social Stigma
Endocarditis Opioid use disorder Prolonged hospitalizations Stigma Bacterial endocarditis Disparities in care Infective endocarditis Injection drug use Intravenous drug use