It is well known that people who use substances are more likely to disengage from services through patient-directed discharge (PDD). This scoping review was designed to gain insights about how institutional factors intersect with patient experiences and contribute to PDD.

Discussion:

The team found that all patients who use substances – in all reviewed qualitative studies – reported predominant experiences of uncaring, stigmatizing interactions with healthcare providers. It was common that medical needs around pain management and withdrawal management were unmet. Hospitals are faced with the challenges to ensure respectful care environments guided by harm reduction policies that will improve engagement of people who use substances in services. At an individual level, it is imperative to provide equitable care to ALL patients. Healthcare providers in all practice settings should be competent to effectively and compassionately care for people who use substances. At an institutional level, policies need to be re-envisioned to support the implementation of effective practices.

Peters, H., Liaukovich, A., Grace, N., Ausman, C., & Kiepek, N. (in press). Opportunities to improve inpatient services and reduce rates of patient-direct discharge among people who use substances. Hospital Practice. https://doi.org/10.1080/21548331.2024.2386924