Barriers and enablers to implementation.

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.背景：酒精和/或药物使用人群（People Who Use Alcohol and/or Drugs, PWUAD）罹患传染病、承受病耻感及反复住院的风险均更高；与未使用酒精和/或药物的人群相比，该人群住院后的死亡概率亦更高。在急性照护机构（acute care settings）中实施伤害减害策略（harm reduction strategies）已被证实可缓解PWUAD所承受的部分伤害。本综述旨在识别并整合与急性照护机构内伤害减害策略实施相关的证据。 方法：本研究采用范围综述（scoping review）方法，针对急性照护机构中面向PWUAD的伤害减害策略实施情况开展调研。由经过JBI培训的研究专员制定检索策略，对Medline、Embase、CINAHL、PsychInfo及Scopus共5个数据库进行检索。由两名独立评审员分别重复完成题名、摘要及全文筛查与数据提取工作，分歧通过协商一致解决，若无法达成一致则交由第三名评审员裁定。研究结果以叙述性描述及表格形式呈现。本研究的方案制定、文献筛查、证据整合、结果反馈以及文献缺口识别环节，均有患者与医疗决策参与者共同参与。 结果：数据库检索共检出14580条题名，最终纳入59项研究。研究识别出多种干预形式，包括药物干预、决策支持、安全使用指导、早期过量用药检测以及睁一只眼闭一只眼（turning a blind eye）式干预。报告的结局指标涉及安全使用、管控使用及使用条件相关内容。研究同时报告了实施障碍与促进因素，相关因素涵盖系统与组织层面、医患沟通以及患者与医护人员的认知态度。 结论：本综述梳理了急性照护机构中已被评估和/或实施的酒精及/或药物伤害减害策略类型，介绍了此类评估中所采用的结局指标类型，并总结了实施过程中的核心障碍与促进因素。本综述可为未来急性照护环境下的伤害减害策略评估与实施工作提供参考资源。