Implementing Hospital-Based Supervised Consumption Services: Healthcare Provider Perspectives on an Innovation in Clinical Care
Creators: Weber, Savannah M
Publisher: name: University of Alberta Library
Year: 2024

<p>Hospital settings are considered high-risk environments for people who use drugs (PWUD). Abstinence-based policies and a lack of access to in-hospital harm reduction services can result in high-risk drug consumption practices, increase the risk of unsupervised overdose, and contribute to high rates of premature discharge and subsequent readmission and mortality among PWUD. Harm reduction, is a pragmatic and humanistic approach to drug use that aims to reduce the negative health, social and legal impacts associated with drug use, drug policies, and drug laws. Supervised consumption services (SCS) are part of a spectrum of harm reduction interventions. Research in community settings have shown that SCS decrease the risk of drug- related morbidity and mortality without increasing drug use or crime. Nevertheless, to date this evidence-based intervention has not been widely implemented in acute care hospitals.<br>
Acute care hospitals differ in important ways from community settings. Effective implementation requires context-specific knowledge to guide the implementation and potential scale-up of hospital-based SCS. Unfortunately, almost no research exists to guide the implementation of SCS in hospital settings. Recognizing these challenges, this thesis adopted an implementation science approach to conduct two qualitative studies on hospital staff perspectives before (Study 1) and after (Study 2) the implementation of a hospital-based SCS.<br>
In Study 1, I performed an exploratory qualitative study informed by the Theoretical Domains Framework to explore perceived acceptability and key considerations for supportive operational practices and professional practice guidance prior to the opening of the hospital- based SCS. I found mixed views regarding the acceptability of the prospective hospital-based SCS. While the service was viewed as a promising solution to reduce drug use-related risks for PWUD, participants also expressed concerns regarding the potential impact to the safety of the hospital environment. The considerations for operating the service and integrating it into patients care place and practice were influenced by competing care duties and varied in how closely they aligned with the intention to offer a low-barrier, patient-centred hospital-based SCS. Lastly, participants’ interpretations of the objectives of their professional practice shaped their views of the acceptability of the SCS.<br>
Following the opening of the hospital-based SCS, in Study 2, I conducted a focused ethnography with hospital staff to further understand the acceptability of hospital-based SCS provision as well as barriers and facilitators to supporting patient access. I found high levels of support for the hospital-based SCS among participants. Yet, there were reports of a lack of awareness regarding the services provided in the SCS and underlying principles of the harm reduction intervention. This knowledge gap was reported as a source of resistance to the service among some hospital staff. Another driver of resistance were beliefs that drug use is an individual or criminal issue. Further, participants believed that staff who were resistant to the service were more likely to deny or discourage a patient from accessing the service. Patient access was also believed to be limited by inconsistent and ineffective screening for illegal drug use, and an ambiguous referral process. Notably, the hospital’s addiction medicine consult team was able to partially address these barriers. Additional barriers that were identified included a lack of transport for patients with limited mobility, the inability to accommodate supervised inhalation, and restricted access for patients’ visitors.</p>