"They Don't Just Need a Handshake or a Handoff, They Need a Hug": A Qualitative Assessment of the Care Transition Experience of Patients with Substance Use Disorders After Hospital Discharge

Abstract

Background: Hospitalizations are common among people with substance use disorders (SUD). Transitioning to follow-up medical and SUD care after discharge is a complex process affected by numerous medical, environmental, and psychosocial factors. Little is known about the experiences of patients with SUD during post-hospitalization care transitions.

Objective: We sought to better understand the care transition experiences of people with SUD in the immediate post-hospitalization period.

Design: We conducted a qualitative study at a single academic hospital site.

Participants: We interviewed 25 recently hospitalized individuals with a SUD.

Approach: Participants were recruited during their hospitalization, and semi-structured interviews were completed via telephone 1-3 weeks after hospital discharge. Interviews were transcribed verbatim and coded. Thematic analysis was performed to inductively extract key themes from coded transcripts.

Key results: We identified six themes pertaining to post-hospitalization care transition experiences: (1) the timing and circumstances of hospital discharge were often unpredictable, which could be destabilizing for patients; (2) careful planning and thorough communication by hospital care teams at discharge were valued by patients but happened inconsistently; (3) substance use disorder treatment was desired and offered frequently via a spectrum of active and passive approaches; (4) patients faced multifarious challenges to following through with a care plan after discharge; (5) community supports and a sense of connection are key facilitators of SUD and medical care linkage after hospital discharge; and (6) proactive outreach, individualized care plans, and continuity of care are valued during post-hospitalization care transitions.

Conclusion: Our themes suggest several distinct and actionable steps to improve post-hospitalization care transitions based on the perspectives of people with SUD who were actively transitioning care. In the hospital, SUD treatment initiation, proactive planning around discharge, and predictability were valued. In the outpatient setting, a supportive community, assistance with basic amenities, and post-discharge outreach were valued.

Keywords: discharge planning; opioid use disorders; opioid-related disorder; patient navigation; risk assessment; transitional care.