Improving Access to Harm Reduction Services in People Who Inject Drugs at a Rural Health System

Abstract

Background: Hospitalists are increasingly responsible for treating infectious complications related to injection-drug use. Despite these complications leading to hospitalizations, harm reduction interventions have not been widely adopted in inpatient settings. Use of naloxone is safe and effective at treating respiratory depression in patients with opioid overdose. The objectives of this study were to assess the need for a multi-modal approach to provide a standard of care in people who inject drugs (PWID), and to create and educate healthcare providers on tools that could improve delivery of harm reduction services. Methods: A review of medical records assessed the need for an intervention to increase access of harm reduction services. PWID 18 years or older who presented to the emergency department (ED) or were hospitalized were eligible. After clinician education, investigators utilized prospective audit to assess and re-educate on intervention use. Primary outcome was percentage of naloxone prescription or education provided at discharge. Secondary outcomes included percentage of disease screening, fentanyl test-strips education, safe-injection practice education, vaccination rates, and healthcare provider survey on naloxone. Results: Sixty-five patients were analyzed for the baseline group and 15 patients for the post-intervention group. The median ages were 32 years (IQR, 19–64) and 32 years (IQR, 20–56) in the baseline and post-intervention groups, respectively. Naloxone prescriptions and education had an absolute percentage increase of 2.1% and 6.7%, respectively. Secondary outcomes were not analyzed due to a delay in the intervention implementation. Conclusions: Barriers to implementation of the intervention led to lack of data for analysis of harm reduction services in PWID in a rural hospital system. Future studies could evaluate other methods to increase these services and assess ways to optimize care through transitions.