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Harm reduction and palliative care: is there a role for supervised drug consumption services?

https://arctichealth.org/en/permalink/ahliterature119483
Source
J Palliat Care. 2012;28(3):175-7
Publication Type
Article
Date
2012
Author
Ryan McNeil
Manal Guirguis-Younger
Author Affiliation
Interdisciplinary Studies Graduate Program, University of British Columbia, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, British Columbia, Canada V6T 1Z1. rmcneil@cfenet.ubc.ca
Source
J Palliat Care. 2012;28(3):175-7
Date
2012
Language
English
Publication Type
Article
Keywords
Canada
Harm Reduction
Health Policy
Health Services Accessibility
Humans
Palliative Care
Substance Abuse, Intravenous
PubMed ID
23098017 View in PubMed
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Harm reduction services as a point-of-entry to and source of end-of-life care and support for homeless and marginally housed persons who use alcohol and/or illicit drugs: a qualitative analysis.

https://arctichealth.org/en/permalink/ahliterature124819
Source
BMC Public Health. 2012;12:312
Publication Type
Article
Date
2012
Author
Ryan McNeil
Manal Guirguis-Younger
Laura B Dilley
Tim D Aubry
Jeffrey Turnbull
Stephen W Hwang
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada. rmcneil@cfenet.ubc.ca
Source
BMC Public Health. 2012;12:312
Date
2012
Language
English
Publication Type
Article
Keywords
Alcohol Drinking - epidemiology - prevention & control
Attitude of Health Personnel
Canada
Female
Harm Reduction
Health Services Accessibility - statistics & numerical data
Homeless Persons - statistics & numerical data
Humans
Interviews as Topic
Male
Professional-Patient Relations
Program Evaluation
Research Design
Residence Characteristics
Risk Management
Severity of Illness Index
Social Support
Street Drugs
Substance Abuse, Intravenous - epidemiology - prevention & control
Substance-Related Disorders - epidemiology - prevention & control
Terminal Care - utilization
Abstract
Homeless and marginally housed persons who use alcohol and/or illicit drugs often have end-of-life care needs that go unmet due to barriers that they face to accessing end-of-life care services. Many homeless and marginally housed persons who use these substances must therefore rely upon alternate sources of end-of-life care and support. This article explores the role of harm reduction services in end-of-life care services delivery to homeless and marginally housed persons who use alcohol and/or illicit drugs.
A qualitative case study design was used to explore end-of-life care services delivery to homeless and marginally housed persons in six Canadian cities. A key objective was to explore the role of harm reduction services. 54 health and social services professionals participated in semi-structured qualitative interviews. All participants reported that they provided care and support to this population at end-of-life.
Harm reduction services (e.g., syringe exchange programs, managed alcohol programs, etc.) were identified as a critical point-of-entry to and source of end-of-life care and support for homeless and marginally housed persons who use alcohol and/or illicit drugs. Where possible, harm reduction services facilitated referrals to end-of-life care services for this population. Harm reduction services also provided end-of-life care and support when members of this population were unable or unwilling to access end-of-life care services, thereby improving quality-of-life and increasing self-determination regarding place-of-death.
While partnerships between harm reduction programs and end-of-life care services are identified as one way to improve access, it is noted that more comprehensive harm reduction services might be needed in end-of-life care settings if they are to engage this underserved population.
Notes
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PubMed ID
22545586 View in PubMed
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Hospitals as a 'risk environment': an ethno-epidemiological study of voluntary and involuntary discharge from hospital against medical advice among people who inject drugs.

https://arctichealth.org/en/permalink/ahliterature105031
Source
Soc Sci Med. 2014 Mar;105:59-66
Publication Type
Article
Date
Mar-2014
Author
Ryan McNeil
Will Small
Evan Wood
Thomas Kerr
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
Source
Soc Sci Med. 2014 Mar;105:59-66
Date
Mar-2014
Language
English
Publication Type
Article
Keywords
Adult
Canada
Cohort Studies
Drug Users - statistics & numerical data
Female
Hospitals
Humans
Male
Middle Aged
Pain Management
Patient Discharge - statistics & numerical data
Patient Dropouts - statistics & numerical data
Qualitative Research
Risk
Social Environment
Substance Abuse, Intravenous
Abstract
People who inject drugs (PWID) experience high levels of HIV/AIDS and hepatitis C (HCV) infection that, together with injection-related complications such as non-fatal overdose and injection-related infections, lead to frequent hospitalizations. However, injection drug-using populations are among those most likely to be discharged from hospital against medical advice, which significantly increases their likelihood of hospital readmission, longer overall hospital stays, and death. In spite of this, little research has been undertaken examining how social-structural forces operating within hospital settings shape the experiences of PWID in receiving care in hospitals and contribute to discharges against medical advice. This ethno-epidemiological study was undertaken in Vancouver, Canada to explore how the social-structural dynamics within hospitals function to produce discharges against medical advice among PWID. In-depth interviews were conducted with thirty PWID recruited from among participants in ongoing observational cohort studies of people who inject drugs who reported that they had been discharged from hospital against medical advice within the previous two years. Data were analyzed thematically, and by drawing on the 'risk environment' framework and concepts of social violence. Our findings illustrate how intersecting social and structural factors led to inadequate pain and withdrawal management, which led to continued drug use in hospital settings. In turn, diverse forms of social control operating to regulate and prevent drug use in hospital settings amplified drug-related risks and increased the likelihood of discharge against medical advice. Given the significant morbidity and health care costs associated with discharge against medical advice among drug-using populations, there is an urgent need to reshape the social-structural contexts of hospital care for PWID by shifting emphasis toward evidence-based pain and drug treatment augmented by harm reduction supports, including supervised drug consumption services.
PubMed ID
24508718 View in PubMed
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Illicit drug use as a challenge to the delivery of end-of-life care services to homeless persons: perceptions of health and social services professionals.

https://arctichealth.org/en/permalink/ahliterature135593
Source
Palliat Med. 2012 Jun;26(4):350-9
Publication Type
Article
Date
Jun-2012
Author
Ryan McNeil
Manal Guirguis-Younger
Author Affiliation
The University of British Columbia, British Columbia, Canada.
Source
Palliat Med. 2012 Jun;26(4):350-9
Date
Jun-2012
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Delivery of Health Care - standards
Disclosure
Health Services Accessibility
Homeless Persons
Humans
Needs Assessment
Qualitative Research
Questionnaires
Substance-Related Disorders - therapy
Terminal Care - standards
Trust
Abstract
Homeless persons tend to die younger than the housed population and have complex, often unmet, end-of-life care needs. High levels of illicit drug use among this population are a particular challenge for health and social services professionals involved in end-of-life care services delivery. This article explores the challenges of end-of-life care services to homeless illicit drug users based on data collected during a national study on end-of-life care services delivery to homeless persons in Canada. The authors conducted qualitative interviews with 50 health and social services professionals involved in health services delivery to homeless persons in five cities. Interviews were transcribed verbatim and analysed thematically. Themes were organised into two domains. First, barriers preventing homeless illicit drug users from accessing end-of-life care services, such as competing priorities (e.g. withdrawal management), lack of trust in healthcare providers and discrimination. Second, challenges to end-of-life care services delivery to this population in health and social care settings, including non-disclosure of illicit drug use, pain and symptom management, interruptions in care, and lack of experience with addictions. The authors identify a need for increased research on the role of harm reduction in end-of-life care settings to address these challenges.
PubMed ID
21464120 View in PubMed
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Impact of supervised drug consumption services on access to and engagement with care at a palliative and supportive care facility for people living with HIV/AIDS: a qualitative study.

https://arctichealth.org/en/permalink/ahliterature256790
Source
J Int AIDS Soc. 2014;17:18855
Publication Type
Article
Date
2014
Author
Ryan McNeil
Laura B Dilley
Manal Guirguis-Younger
Stephen W Hwang
Will Small
Author Affiliation
British Columbia Centre or Excellence in HIV/AIDS, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada; rmcneil@cfenet.ubc.ca.
Source
J Int AIDS Soc. 2014;17:18855
Date
2014
Language
English
Publication Type
Article
Keywords
Adult
Antiretroviral Therapy, Highly Active
British Columbia
Female
HIV Infections - complications - drug therapy - therapy
Health Services Accessibility - organization & administration
Humans
Interviews as Topic
Male
Middle Aged
Palliative Care - methods - organization & administration
Qualitative Research
Substance Abuse Treatment Centers - methods - organization & administration
Substance-Related Disorders - complications - therapy
Abstract
Improvements in the availability and effectiveness of highly active antiretroviral therapy (HAART) have prolonged the lives of people living with HIV/AIDS. However, mortality rates have remained high among populations that encounter barriers to accessing and adhering to HAART, notably people who use drugs. This population consequently has a high burden of illness and complex palliative and supportive care needs, but is often unable to access these services due to anti-drug policies and discrimination. In Vancouver, Canada, the Dr. Peter Centre (DPC), which operates a 24-bed residential HIV/AIDS care facility, has sought to improve access to palliative and supportive care services by adopting a comprehensive harm reduction strategy, including supervised injection services. We undertook this study to explore how the integration of comprehensive harm reduction services into this setting shapes access to and engagement with care.
Qualitative interviews were conducted with 13 DPC residents between November 2010 and August 2011. Interviews made use of a semistructured interview guide which facilitated discussion regarding how the DPC Residence's model of care (a) shaped healthcare access, (b) influenced healthcare interactions and (c) impacted drug use practices and overall health. Interview transcripts were analysed thematically.
Participant accounts highlight how the harm reduction policy altered the structural-environmental context of healthcare services and thus mediated access to palliative and supportive care services. Furthermore, this approach fostered an atmosphere in which drug use could be discussed without the risk of punitive action, and thus increased openness between residents and staff. Finally, participants reported that the environmental supports provided by the DPC Residence decreased drug-related risks and improved health outcomes, including HAART adherence and survival.
This study highlights how adopting comprehensive harm reduction services can serve to improve access and equity in palliative and supportive care for drug-using populations.
Notes
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PubMed ID
24629844 View in PubMed
Less detail

Learning and knowledge-integration strategies of nurses and client care workers serving homeless persons.

https://arctichealth.org/en/permalink/ahliterature149344
Source
Can J Nurs Res. 2009 Jun;41(2):21-34
Publication Type
Article
Date
Jun-2009
Author
Manal Guirguis-Younger
Ryan McNeil
Vivien Runnels
Author Affiliation
Faculty of Human Sciences, Saint Paul University, Ottawa, Ontario, Canada.
Source
Can J Nurs Res. 2009 Jun;41(2):21-34
Date
Jun-2009
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Clinical Competence
Communication Barriers
Evidence-Based Practice - education - organization & administration
Health Knowledge, Attitudes, Practice
Health Services Accessibility - organization & administration
Health Services Needs and Demand - organization & administration
Healthcare Disparities - organization & administration
Homeless Persons - psychology - statistics & numerical data
Humans
Interprofessional Relations
Nurse's Role - psychology
Nurse-Patient Relations
Nursing Methodology Research
Nursing Staff - education - psychology
Patient-Centered Care - organization & administration
Qualitative Research
Questionnaires
Self Efficacy
Social Support
Urban Population
Abstract
Health-care workers serving homeless persons often face difficulties in addressing the needs of this population due to the complexity of the health challenges and gaps in clinical knowledge. How can health-care workers enhance their ability to care for this population? The authors explore the learning and knowledge-integration strategies of nurses and client care workers employed by organizations targeting homeless persons in a Canadian city. Semi-structured qualitative interviews were conducted with 8 health-care workers.The data were examined using narrative analysis and constant comparative analysis. Three strategies were identified: integrating past experiences into clinical practice, interacting with clients to identify care needs and boundaries, and engaging in interprofessional knowledge exchange. A better understanding of these strategies may help nursing programs and health-services organizations to equip health-care workers with the skills they need to serve homeless persons.
PubMed ID
19650511 View in PubMed
Less detail

Learning to account for the social determinants of health affecting homeless persons.

https://arctichealth.org/en/permalink/ahliterature114851
Source
Med Educ. 2013 May;47(5):485-94
Publication Type
Article
Date
May-2013
Author
Ryan McNeil
Manal Guirguis-Younger
Laura B Dilley
Jeffrey Turnbull
Stephen W Hwang
Author Affiliation
BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada. rmcneil@cfenet.ubc.ca
Source
Med Educ. 2013 May;47(5):485-94
Date
May-2013
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Clinical Competence - standards
Health Personnel - education
Health Services Accessibility
Health Status Disparities
Homeless Persons
Humans
Problem-Based Learning
Professional Practice
Professional-Patient Relations
Questionnaires
Self Efficacy
Abstract
Intersecting social determinants of health constrain access to care and treatment adherence among homeless populations. Because clinicians seldom receive training in the social determinants of health, they may be unprepared to account for or address these factors when developing treatment strategies for homeless individuals.
This study explored: (i) clinicians' preparedness to provide care responsive to the social determinants of health in homeless populations, and (ii) the steps taken by clinicians to overcome shortcomings in their clinical training in regard to the social determinants of health.
Qualitative interviews were conducted with doctors (n = 6) and nurses (n = 18) in six Canadian cities. Participants had at least 2 years of experience in providing care to homeless populations. Interview transcripts were analysed using methods of constant comparison.
Participants highlighted how, when first providing care to this population, they were unprepared to account for or address social determinants shaping the health of homeless persons. However, participants recognised the necessity of addressing these factors to situate care within the social and structural contexts of homelessness. Participants' accounts illustrated that experiential learning was critical to increasing capacity to provide care responsive to the social determinants of health. Experiential learning was a continuous process that involved: (i) engaging with homeless persons in multiple settings and contexts to inform treatment strategies; (ii) evaluating the efficacy of treatment strategies through continued observation and critical reflection, and (iii) adjusting clinical practice to reflect observations and new knowledge.
This study underscores the need for greater emphasis on the social determinants of health in medical education in the context of homelessness. These insights may help to inform the development and design of service-learning initiatives that integrate understandings of the social determinants of health, and thus potentially improve the readiness of clinicians to address the complex factors that shape the health of homeless populations.
PubMed ID
23574061 View in PubMed
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7 records – page 1 of 1.