Geocoded emergency department (ED) data have allowed for the development and evaluation of novel interventions for the prevention of violence in cities outside of the United States. First implemented in Cardiff, United Kingdom, collection of these data provides public health agencies, community organizations, and law enforcement with place-based information on assaults. The purpose of this study was to assess the feasibility of translating this model within the electronic medical record (EMR) in the United States. A new EMR module based on the Cardiff Model was developed and integrated into the existing ED EMR. Data were collected for all patients reporting an assaultive injury upon arrival to the ED. Emergency department nurses were subsequently recruited to participate in 2 surveys and a focus group to evaluate the implementation and to provide qualitative feedback to enhance integration. Nurses completed EMR questions in 98.2% of patients reporting to the ED over the study period. More than 90% of survey respondents were satisfied with their participation, and most felt that the questions were useful for clinical care (79/70%), were integrated well into workflow (89/90%), and were congruent with the ED and hospital goals and mission (93/98%). Focus group themes centered on ED culture, external factors, and internal workflow. It is feasible to implement place-based, assault-related injury-specific questions into the EMR with minimal disruption of workflow and triage times. Nurses, as key members of the ED team, are receptive to participating in the collection of population health data that may inform community violence prevention activities.
BackgroundDrug overdose (OD) is the leading cause of accidental death in the United States and most of these deaths involve opioids. Despite research linking opioid abuse to mental illness, and evidence suggesting a large portion of opioid OD deaths are suicides, OD prevention strategies scarcely take into account mental health risk factors.MethodsWe examined a sample of heroin or other opioid users enrolled in an intervention study to determine the prevalence of overdose, the prevalence of suicide attempts in overdose, and whether those with higher levels of psychiatric symptomatology would be more likely to experience a recent OD compared to other opioid users. By performing bivariate analyses and multivariate logistic regression models that controlled for poly drug use, criminal justice status, age, race, gender, and education, we evaluated the association of severe depression, severe anxiety, posttraumatic stress disorder (PTSD) and, psychosis and past three-month OD.ResultsJust over 12% (45/368) of recent opioid users reported a recent overdose. Four of these recent overdose victims reported that the overdose was a suicide attempt. Multiple logistic regression analysis revealed that severe depression (odds ratio 2.46; 95% CI: 1.24, 4.89), PTSD (odds ratio: 2.77; 95% CI: 1.37–5.60) and psychosis (odds ratio 2.39; 95% CI: 1.10–5.15) were significantly associated with elevated odds for OD.ConclusionsFindings suggest systematic mental health symptom screening and connection to mental health treatment for opioid users—especially those identified with OD—may be critical for OD prevention.
Substance misuse intervention in healthcare settings is becoming a US national priority, especially in the dissemination and implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT). Yet, the referral to treatment component of SBIRT is understudied. This proof-of-concept investigation tested an enhanced coordinated hospital-community two session brief intervention designed to facilitate the referral to treatment of hospitalized medical patients with an alcohol use disorder. Participants (N = 9) attended the second session of the brief intervention held in the community in most cases (56%), while one out of three (33%) received some level of post-brief intervention alcohol and/or other drug treatment. Alcohol use and alcohol-related problems also statistically improved. Based, in part, on the results plus the widespread dissemination of SBIRT, next step investigations of brief interventions to help bridge hospitalized medical patients in need to community substance abuse treatment are warranted.
Background and objectiveThis project links population data to the Wisconsin Violent Death Reporting System (WVDRS) to determine the extent to which firearm possession criteria are being followed as well as the potential impact of the adoption of proposed possession criteria.Design and study populationCriminal justice data for WVDRS homicide suspects and victims and suicide decedents 2008–2011 and a sample of matched control group of driver’s license holders (to characterise the state population) will be abstracted.MethodsIndividual legal possession statuses (prohibited/not prohibited) under each current and expanded criterion will be determined. Proportions of interest will be calculated from two-way contingency tables, and tests between groups with categorical variables (eg, criterion is met or not) will be performed with Fisher’s exact or binomial proportion tests. Tests between groups with continuous variables (eg, number of misdemeanours) will be performed by zero inflated negative binomial regression. Area under the receiver operating characteristic curve will be used to quantify the prediction accuracy of specific univariate or multivariate logistic model for prediction. Inverse probability weighting will be used for analyses that extend from matched controls to the general state population of license holders.DiscussionLinked data sets and partnerships are challenging, but necessary for comprehensive public health research. Results of this study will contribute knowledge on the proportion of prohibited suspects and suicide decedents that used firearms in violent deaths and, if applying expanded criteria would have increased prohibited persons. This study will also investigate risk and protective factors for being a victim of homicide.
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