RESUMEN
BACKGROUND: Opioid addiction and overdose is a public health problem in the United States and is expected to remain with substance use increasing due to the COVID-19 pandemic. Communities that approach this issue through multi-sector partnerships experience more positive health outcomes. Understanding motivation for stakeholder engagement in these efforts is essential to successful adoption, implementation, and sustainability particularly in the shifting landscape of needs and resources. METHODS: A formative evaluation was conducted on the C.L.E.A.R. Program in Massachusetts, a state heavily impacted by the opioid epidemic. A stakeholder power analysis identified appropriate stakeholders for the study (n = 9). The Consolidated Framework for Implementation Research (CFIR) guided data collection and analysis. Surveys (n = 8) examined perception and attitudes on the program; motivations and communication for engagement; and, benefits and barriers to collaboration. Stakeholder interviews (n = 6) explored the quantitative findings in more detail. Surveys were analyzed using descriptive statistics and a content analysis with deductive approach was conducted for stakeholder interviews. The Diffusion of Innovation (DOI) Theory guided recommendations for communications to engage stakeholders. RESULTS: Agencies represented a range of sectors and the majority (n = 5) were familiar with the C.L.E.A.R. PROGRAM: Despite the many strengths of the program and existing collaboration, based on the coding densities of each CFIR construct stakeholders identified crucial gaps in the services the program provided and noted that the overall infrastructure of the program could be enhanced. Opportunities for strategic communication to address the stages of DOI align with the gaps identified in the CFIR domains to result in increased agency collaboration and expansion of services into the surrounding communities to ensure sustainability of the C.L.E.A.R. CONCLUSIONS: This study explored factors necessary for ongoing multi-sector collaboration and sustainability of an existing community-based program especially given the changing context from COVID-19. Findings informed both program revisions and communication strategies to promote the program to new and existing collaborating agencies and the community served, and identify effective communication approaches across sectors. This is essential for successful implementation and sustainability of the program, especially as it is adapted and expanded to address post-pandemic times. TRIAL REGISTRATION: This study does not report results of a health care intervention on human participants, however it was reviewed and determined an exempt study with the Boston University Institutional Review Board (IRB #H-42107).
Asunto(s)
COVID-19 , Sobredosis de Opiáceos , Humanos , Estados Unidos , Pandemias , COVID-19/prevención & control , Atención a la Salud/métodos , ComunicaciónRESUMEN
This study aims to describe infectious complications in both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) patients with sustained return of spontaneous circulation (ROSC) and to compare differences in antimicrobial treatment and outcomes between the two groups. This was a retrospective, single-center, observational study. Adult patients (≥ 18 years) with OHCA or IHCA who had sustained ROSC between December 2007 to March 2015 were included. Blood, urine, sputum, and other fluid cultures, as well as radiologic imaging, were obtained at the discretion of the treating clinical teams. 275 IHCA and 318 OHCA patients were included in the analysis. We found evidence of infection in 181 IHCA and 168 OHCA patients. Significant differences were found between the IHCA and OHCA group in terms of initial rhythm, duration of arrest (10 min vs. 20, p = < 0.001), targeted temperature management (30% vs. 73%, p = < 0.001), and post-arrest infection rates (66% vs 53%, p = 0.001). 95% of IHCA and 82% of OHCA patients received antimicrobial treatment in the post-cardiac arrest period. The source of infection in both groups was largely respiratory, followed by urinary. Gram-positive cocci and gram-negative rods were the most common organisms identified among subjects with culture-proven bacteremia. Infections in the post-arrest period were common in both OHCA and IHCA. We found significantly more infections in IHCA compared to OHCA patients. The most common infection category was respiratory and the most common organism isolated from sputum cultures was Staphylococcus aureus coagulase-positive. The incidence of culture-positive bacteremia was similar in both OHCA and IHCA cohorts but overall lower than previously reported.