A feasible model for early intervention for high-risk substance use in the emergency department setting

Longitudinal within- and between-person associations of substance use, social influences, and loneliness among adolescents and emerging adults who use drugs

Loneliness is a public health problem causing morbidity and mortality. Individuals with substance use problems are often lonelier than the general population. We evaluate the longitudinal associations between social influences, substance use, and loneliness among adolescents and young adults recruited from an urban Emergency Department (ED). We use secondary data from a natural history study of N=599 youth (ages 14-24) who used drugs at baseline and completed biannual assessments for 24 months; 58% presented to the ED for an assault-related injury and a comparison group comprised 42% presenting for other reasons. Measures assessed cannabis use, alcohol use, and loneliness. Using GEE models, we evaluated the relationships between social influences (peers, parents), substance use, and loneliness via longitudinal data, de-coupling within- and between-person effects. Men reported lower loneliness over time. At the between-person level, individuals with greater alcohol and cannabis use severity and negative peer influences had greater loneliness; positive parental influences were associated with less loneliness. At the within-person level, greater alcohol use severity, negative peer influences, and parental substance use corresponded to increases in loneliness; positive parental influences corresponded to decreases in loneliness. Youth with more severe alcohol and cannabis use had greater loneliness over time. Within individuals, peer and parental social influences were particularly salient markers of loneliness. An ED visit provides an opportunity for linkage to personalized, supportive interventions to curtail negative outcomes of substance use and loneliness.

Prevalence of Alcohol Consumption in Emergency department presentations (PACE) in Queensland, Australia, using alcohol biomarkers ethanol and phosphatidylethanol: an observational study protocol

INTRODUCTION

Alcohol use in patients presenting to the emergency department (ED) is a significant problem in many countries. There is a need for valid and reliable surveillance of the prevalence of alcohol use in patients presenting to the ED, to provide a more complete picture of the risk factors and inform targeted public health interventions. This PACE study will use two biomarkers, blood ethanol and phosphatidylethanol (PEth), to determine the patterns, presence and level of alcohol use in patients presenting to an Australian ED.

METHODS AND ANALYSIS

This is an observational prevalence study involving the secondary use of routinely collected blood samples from patients presenting to the Royal Brisbane and Women's Hospital (RBWH) Emergency and Trauma Centre (ETC). Samples will be tested for acute and medium-term alcohol intake using the two biomarkers blood ethanol and PEth respectively, over one collection period of 10-12 days. Descriptive statistics such as frequencies, percentages, means, SD, medians and IQRs, will be used to describe the prevalence, pattern and distribution of acute and medium-term alcohol intake in the study sample. The correlation between acute and medium-term alcohol intake levels will also be examined.

ETHICS AND DISSEMINATION

This study has been approved by the RBWH Human Research Ethics Committee (reference, LNR/2019/QRBW/56859). Findings will be disseminated to key stakeholders such as RBWH ETC, Australasian College for Emergency Medicine, Royal Australasian College of Surgeons, Statewide Clinical Networks, and used to inform clinicians and hospital services. Findings will be submitted for publication in peer-reviewed journals and presentation at appropriate conferences.

Identifying opportunities for health promotion and intervention in the ED

BACKGROUND

ED staff assess patients with modifiable risk factors for acute and chronic illness. Health promotion interventions delivered in the ED have been advocated for these patients. The engagement of staff is essential to provide effective screening and brief interventions for patients. This survey aimed to assess if staff support the ED as an environment for health promotion.

METHODS

A multicentre, structured survey was conducted in four EDs in Scotland from 2017 to 2018. Physician and nursing staff at two teaching and two district general hospitals (n=423) were study eligible and offered a multicomponent survey. Outcomes measured included perceived barriers to practice and risk factor specific ED interventions.

RESULTS

Of the 283 respondents, 116 (41%) were physicians and 167 (59%) were nurses. More physicians (86.1%) than nurses (49.7%) reported offering health promotion interventions. Time constraints and a lack of health promotion infrastructure in the ED were cited as challenges to intervention delivery. Staff believed that alcohol (n=170/283, 60.1%) and drug misuse (n=173/283, 61.1%) were more appropriately managed in the ED than primary care. ED staff believed same day brief interventions were more appropriate when alcohol/drug misuse and smoking were directly related to ED presentations.

DISCUSSION AND CONCLUSIONS

Staff support the concept of the ED as a potential environment for offering health promotion interventions. ED physicians and nurses have different perspectives on the delivery of health promotion. The role of the ED in health promotion is likely to be multimodal and dependant on the reason for ED attendance.

Identification of emergency department patients for referral to rapid-access addiction services

OBJECTIVES

Substance-related emergency department (ED) visits are rapidly increasing. Despite this finding, many EDs do not have access to on-site addiction services. This study characterized substance-related ED presentations and assessed the ED health care team's perceived need for an on-site rapid-access addiction clinic for direct patient referral from the ED.

METHODS

This prospectively enrolled cohort study was conducted at an urban tertiary care ED from June to August 2018. Adult ED patients with problematic or high-risk substance use were enrolled by ED staff using a one-page form. The electronic and paper records from the index ED visit were reviewed. The primary outcome evaluated whether the ED health care team would have referred the patient to an on-site rapid-access addiction clinic, if one were available.

RESULTS

We received 557 enrolment forms and 458 were included in the analysis. Median age was 35 years, and 64% of included patients were male. Alcohol was the most commonly reported substance of problematic or high-risk use (60%). Previous ED visits within 7 days of the index visit were made by 28% of patients. The ED health care team indicated "Yes" for rapid-access addiction clinic referral from the ED for 66% of patients, with a mean of 4.3 patients referred per day during the study period.

CONCLUSIONS

At least four patients per day would have been referred to an on-site rapid-access addiction clinic from the ED, had one been available. This indicates a gap in care and collaborating with other sites that have successfully implemented this clinic model is an important next step.