Major Barriers and Facilitators to Transitions of Care for Patients Hospitalized with Infectious Complications of Opioid Use Disorder: A Multi-site, Qualitative Analysis of Expert Stakeholders

Author: Sarah Kattakuzhy Vivian Wang Meghan Derenoncourt Christopher Brokus Joseph Carpenter Alaina Steck Irene Kuo Jill Catalanotti Hana Akselrod Kaylee Burgan Greer Burkholder Ellen Eaton Hana Henry Masur Shyam Kottilil Elana Rosenthal

Theme: Social Science & Policy Research Year: 2022

Given the rise in infectious complications of opioid use disorder (OUD), hospitalization and
transitions from inpatient to outpatient care remain critical touchpoints in the OUD care continuum.
This qualitative study aimed to analyze major barriers and facilitators to transitions of care for
hospitalized patients with OUD.
The CHOICE investigation is a multi-site collaboration across four U.S. academic medical centers with
high regional overdose mortality. Semi-structured interviews were conducted with 24 expert
stakeholders with relevant professional experience as healthcare providers, harm reductionists,
and/or public health and nonprofit workers. De-identified transcripts were coded utilizing qualitative
analysis software (NVivo 11). Thematic analysis involved a hybrid deductive and inductive approach
with creation of within site and between site themes.
Core thematic findings were organized around a social-ecological (SE) model (see Figure 1). We
identified seven key themes across the four sites, including Stigma, Communication, Standardization,
Resources, Harm Reduction, Environment, and Policy/Advocacy. Stigma was pervasive across the SE
spheres of influence, and permeated all aspects of care from judgement around the use of
medication for OUD to presumed criminality. Lack of standards around hospital-based OUD care was
a recurrent challenge, with unclear policies and variability rooted in lack of knowledge, and
perpetuated by learned helplessness. Harm Reduction in the context of transitions was defined as
centering the patient experience, with an emphasis on collocated services and addressing social
determinants of health.
There is an urgent need to standardize OUD treatment, grounded in stigma and harm reduction.
Presentation of CHOICE data will provide the opportunity to discuss potential solutions and policy
implications across multiple socio-ecologic spheres, which attendees can apply directly to their
communities. These findings move beyond single-site observational data to cohesively describe
vulnerabilities experienced by individuals with OUD during key touchpoints with the healthcare
Disclosure of Interest Statement:
S Kattakuzhy has received investigator-initiated research grants from Gilead Sciences payable to the
institution. E Rosenthal has received investigator-initiated research grants from Gilead Sciences,
Merck, and John C. Martin Foundation payable to the institution.

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