Experiences of care among individuals with opioid use disorder-associated endocarditis and their healthcare providers: Results from a qualitative study

2019 
Abstract 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.
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