Summary of included articles.

BackgroundPeople who use alcohol and/or drugs (PWUAD) are at higher risk of infectious disease, experiencing stigma, and recurrent hospitalization. Further, they have a higher likelihood of death once hospitalized when compared to people who do not use drugs and/or alcohol. The use of harm reduction strategies within acute care settings has shown promise in alleviating some of the harms experienced by PWUAD. This review aimed to identify and synthesize evidence related to the implementation of harm reduction strategies in acute care settings.MethodsA scoping review investigating harm reduction strategies implemented in acute care settings for PWUAD was conducted. A search strategy developed by a JBI-trained specialist was used to search five databases (Medline, Embase, CINAHL, PsychInfo and Scopus). Screening of titles, abstracts and full texts, and data extraction was done in duplicate by two independent reviewers. Discrepancies were resolved by consensus or with a third reviewer. Results were reported narratively and in tables. Both patients and healthcare decision makers contributing to the development of the protocol, article screening, synthesis and feedback of results, and the identification of gaps in the literature.FindingsThe database search identified 14,580 titles, with 59 studies included in this review. A variety of intervention modalities including pharmacological, decision support, safer consumption, early overdose detection and turning a blind eye were identified. Reported outcome measures related to safer use, managed use, and conditions of use. Reported barriers and enablers to implementation related to system and organizational factors, patient-provider communication, and patient and provider perspectives.ConclusionThis review outlines the types of alcohol and/or drug harm reduction strategies, which have been evaluated and/or implemented in acute care settings, the type of outcome measures used in these evaluations and summarizes key barriers and enablers to implementation. This review has the potential to serve as a resource for future harm reduction evaluation and implementation efforts in the context of acute care settings.研究背景：酒精和/或药物使用人群（People who use alcohol and/or drugs, PWUAD）罹患感染性疾病、遭遇病耻感以及反复住院的风险均显著升高。此外，与未使用酒精和/或药物的人群相比，该人群住院期间的死亡风险亦更高。在急诊医疗环境（acute care settings）中应用减害策略（harm reduction strategies），已被证实可缓解PWUAD所遭受的部分伤害。本综述旨在识别并整合与急诊医疗环境中减害策略实施相关的研究证据。 研究方法：本研究采用范围综述（scoping review）方法，针对PWUAD在急诊医疗环境中的减害策略实施情况开展调研。由接受过JBI培训的专家制定的检索策略，用于检索Medline、Embase、CINAHL、PsychInfo及Scopus共5个数据库。两名独立评审员分别对文献标题、摘要及全文进行筛选，并开展数据提取工作，所有操作均重复进行。评审意见存在分歧时，通过协商一致解决，或由第三名评审员协助裁决。研究结果以叙述性描述及表格形式呈现。患者及医疗决策参与者全程参与了方案制定、文献筛选、证据整合、结果反馈以及文献研究空白的识别工作。 研究结果：数据库检索共获取14580条文献标题，最终纳入本综述的研究共59项。本研究共识别出多种干预形式，包括药物干预、决策支持、安全消费、药物过量（overdose）早期检测以及默许式干预。研究所报告的结局指标涵盖安全使用、可控使用以及使用条件相关维度。研究所报告的实施障碍与促进因素，涉及系统与组织层面因素、医患沟通情况，以及患者与医护人员的视角。 研究结论：本综述梳理了已在急诊医疗环境中得到评估和/或实施的酒精及/或药物减害策略类型，以及这些评估中所采用的结局指标类型，并总结了实施过程中的关键障碍与促进因素。本综述可为未来急诊医疗环境下的减害策略评估与实施工作提供参考依据。