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Objective: Food insecurity is a prevalent social risk among emergency department (ED) patients. Patients who may benefit from food insecurity resources may be identified via ED-based screening; however, many patients experience difficulty accessing resources after discharge. Co-locating resources in or near the ED may improve utilization by patients, but this approach remains largely unstudied. This study characterized the acceptance and use of a food voucher redeemable at a hospital food market for patients who screened positive for food insecurity during their ED visit.Methods: This prospective cohort study, conducted at a single county-funded ED, included consecutive adult patients who presented on weekdays between 8 AM–8 PM from July–October 2022 and consented to research participation. We excluded patients who required resuscitation on arrival or could not provide written informed consent in English. Study participants completed a paper version of the two-question Hunger Vital Sign screening tool, administered by research staff. Participants who screened positive received a uniquely numbered $30 food voucher redeemable at the hospital’s co-located food market. Voucher redemption was quantified through regular evaluation of market receipt records at 30-day intervals. The primary outcome was the proportion of redeemed vouchers. Secondary outcomes included the proportion of participants screening positive for food insecurity, proportion of participants accepting vouchers, and associated descriptive statistics.Results: Of the 396 eligible individuals approached, 377 (95.2%) consented and completed food insecurity screening. Most were middle-aged (median 53 years, interquartile range 30–58 years), 191 were female (50.4%), 242 were Black (63.9%), and 343 were non-Hispanic (91.0%). Of the participants, 228 (60.2%) screened positive for food insecurity and 224 received vouchers (98.2%), of which 86 were redeemed (38.4%) a median of nine days after the ED visit.Conclusion: A high proportion of participants screened positive for food insecurity and accepted food vouchers; however, less than half of all vouchers were redeemed at the co-located food market. These results imply ED food voucher distribution for food insecurity is feasible, but co-location of resources alone may be insufficient in addressing the social risk and alludes to a limited understanding of facilitators and barriers to resource utilization following ED-based social needs screening.

Introduction: The degree to which individual patients use multiple emergency departments (EDs) is not well-characterized. We determined the degree of overlap in ED population between three geographically proximate hospitals. Methods: This retrospective cohort study reviewed administrative hospital records from 2003 to 2007 for patients registered to receive ED services at an urban academic, urban community, and suburban community ED located within 10 miles of one another. We determined the proportion who sought care at multiple EDs and secondarily characterized patterns of repeat encounters. Results: There were 795,176 encounters involving 282,903 patients. There were 89,776 (31%) patients with multiple encounters to a single ED and 39,920 (14%) patients who sought care from multiple EDs. The 39,920 patients who sought care from multiple EDs generated 185,629 (23%) of all encounters. Patients with repeat encounters involving multiple EDs were more likely to be frequent or highly frequent users (30%) than patients with multiple encounters to a single ED (14%). Conclusion: While only 14% of patients received care from more than one ED, they were responsible for a quarter of ED encounters. Patients who use multiple EDs are more often frequent or highly frequent users than are repeat ED visitors to the same ED. Overlap between ED populations is sufficient to warrant consideration by multiple domains of research, practice, and policy. [West J Emerg Med. 2015;16(2):229–233.]

Emergency departments (EDs) have played a major role in the science and practice of HIV population screening. After decades of experience, EDs have demonstrated the capacity to provide testing and linkage to care to large volumes of patients, particularly those who do not otherwise engage the healthcare system. Efforts to expand ED HIV screening in the United States have been accelerated by a collaborative national network of emergency physicians and other stakeholders called EMTIDE (Emergency Medicine Transmissible Infectious Diseases and Epidemics). As the COVID-19 pandemic evolves, EDs nationwide are being tasked with diagnosing and managing COVID-19 in a myriad of capacities, adopting varied approaches based in part on know-how, local disease trends, and the supply chain. The objective of this article is to broadly summarize the lessons learned from decades of ED HIV screening and provide guidance for many analogous issues and challenges in population screening for COVID-19. Over time, and with the accumulated experience from other epidemics, ED screening should develop into an overarching discipline in which the disease in question may vary, but the efficiency of response is increased by prior knowledge and understanding.

Objectives. To determine whether the Communities That HEAL (CTH) intervention is effective in increasing naloxone distribution compared with usual care. Methods. The HEALing (Helping to End Addiction Long-Term) Communities Study (HCS) is a cluster-randomized, parallel-arm, wait-list controlled implementation science trial testing the impact of the CTH intervention on increasing the use of evidence-based practices to lower opioid-related overdose deaths. Communities (n = 67) highly impacted by opioid overdose in Kentucky, Massachusetts, New York, and Ohio were allocated to CTH intervention (n = 34) or wait-list comparison (usual care; n = 33) arms. The primary outcome for this study was the number of naloxone units distributed in HCS communities during the comparison period (July 1, 2021‒June 30, 2022), examined using an intent-to-treat negative binomial regression model. Results. Naloxone distribution was 79% higher in the CTH intervention versus usual care arm (adjusted relative rate = 1.79; 95% confidence interval = 1.28, 2.51; P =.001; adjusted rates of naloxone distribution 3378 vs 1884 naloxone units per 100 000 residents), when controlling for urban‒rural status, state, baseline opioid-related overdose death rate, and baseline naloxone distribution rate. Conclusions. The CTH intervention increased naloxone distribution compared with usual care in communities highly impacted by the opioid crisis. Trial Registration. ClinicalTrials.gov identifier: NCT04111939. (Am J Public Health. 2025;115(1):83–94. https://doi.org/10.2105/AJPH.2024.307845) [ABSTRACT FROM AUTHOR]

Introduction: The emergency department (ED) may be an optimal setting to screen for substance use disorders (SUDs) and co-occurring psychiatric disorders (CODs). We report on the frequency of problematic substance use and comorbid elevated mental health symptoms detected during a 1-year implementation period of an ED-based SUD/COD screening approach within an established ED HIV screening program. Methods: Patients (N = 1,924) were approached by dedicated HIV screening staff in an urban, Midwestern ED. Patients first completed measures assessing problematic alcohol (Alcohol Use Disorder Identification Test-Concise [AUDIT-C]) and substance use across 10 categories of substances (National Institute on Drug Abuse–Modified Alcohol, Smoking, and Substance Involvement Screening Test [NIDA-Modified ASSIST]). Patients with positive alcohol and/or substance use screens completed measures assessing symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), and post-traumatic stress disorder (PTSD) (PTSD Checklist-Civilian [PCL-C]). Results: Patients were predominantly male (60.3%) with a mean age of 38.1 years (SD = 13.0); most identified as White (50.8%) or Black (44.8%). A majority (58.5%) had a positive screen for problematic alcohol and/or other substance use. Of those with a positive substance use screen (n = 1,126), 47.0% had a positive screen on one or more of the mental health measures with 32.1% endorsing elevated depressive symptoms, 29.6% endorsing elevated PTSD-related symptoms, and 28.5% endorsing elevated anxiety symptoms. Conclusions: Among those receiving ED HIV screening, a majority endorsed problematic alcohol and/or other substance use and co-occurring elevated mental health symptoms. Substance use and mental health screening programs that can be integrated within other ED preventive services may enhance the identification of individuals in need of further assessment, referral, or linkage to substance use treatment services. [ABSTRACT FROM AUTHOR]