Search

BackgroundTreatment for partners of patients diagnosed with sexually transmitted infections (STIs), referred to as expedited partner therapy (EPT), is infrequently used in emergency departments (EDs). This was a pilot program to initiate and evaluate EPT through medication-in-hand (“take-home”) kits or paper prescriptions. This study aimed to assess the frequency of EPT prescribing, the efficacy of a randomized best practice advisory (BPA) on the uptake of EPT, perceptions of ED clinicians regarding the EPT pilot, and factors associated with EPT prescribing.MethodsThis pilot study was conducted at an academic ED in the midwestern US between August and October 2021. The primary outcome was EPT prescription uptake and the BPA impact was measured via chart abstraction and analyzed through summary statistics and Fisher’s exact test. The secondary outcome of barriers and facilitators to program implementation was analyzed through ED staff interviews (physicians, physician assistants, and nurses). A rapid qualitative assessment method for the analysis of the interviews was employed.ResultsFifty-two ED patients were treated for chlamydia/gonorrhea during the study period. EPT was offered to 25% (95% CI 15%-39%) of patients. EPT was prescribed twice as often (85% vs. 38%;pConclusionsIn this pilot EPT program, EPT was provided to 25% of ED patients who appeared eligible to receive it. The interruptive pop-up alert BPA significantly increased EPT prescribing. Barriers identified to EPT prescribing can be the subject of future interventions to improve ED EPT provision.

BackgroundEmergency departments (EDs) are the primary source of healthcare for many patients diagnosed with sexually transmitted infections (STIs). Expedited partner therapy (EPT), treating the partner of patients with STIs without an exam of the partner, is an evidence-based practice for patients who might not otherwise seek care. Little is known about EPT use in the ED. In a national survey, we describe ED medical directors’ knowledge, attitudes, and practices of EPT.MethodsA cross-sectional internet survey of medical directors from academic EDs using the Academy of Academic Administrators of Emergency Medicine (AAAEM) Benchmarking Group from July through September 2020. Primary outcomes were EPT awareness, support, and use. The survey also examined barriers and facilitators. Multivariable regressions explored predictors of EPT support.ResultsForty-eight of 70 (69%) medical directors responded, representing EDs with a median volume of 67,840 patients/year. Awareness of EPT was high (73%), but fewer knew how to prescribe it (38%), and only 19% of EDs had implemented EPT. Most (79%) supported EPT and were more likely to if they were aware of EPT (89% vs. 54%) p=0.01. Of non-implementers, 41% thought EPT was feasible, and 56% thought departmental support would be likely. Of potential barriers, ED directors were most concerned about legal liability (25% moderately to extremely). Benefits of EPT were rated with similar importance, with preventing sequelae of untreated STIs most frequently rated as “extremely important” (44%). Linear regression showed increased years in practice, and ED’s proportion of Medicaid patients was significantly positively associated with support for EPT.ConclusionED medical directors expressed strong support for EPT and reasonable levels of feasibility for implementation but low utilization. Our findings highlight the need to identify mechanisms for EPT implementation and develop ED-tailored implementation tools to bolster this practice.

Health disparities in heart failure (HF) show that Black patients face greater ED utilization and worse clinical outcomes. Transitional care post-HF hospitalization, such as 7-day early follow-up visits, may prevent ED returns. We examine whether early follow-up is associated with lower ED returns visits within 30 days and whether Black race is associated with receiving early follow-up after HF hospitalization. This was a retrospective cohort analysis of all Black and White adult patients at 13 hospitals in Michigan hospitalized for HF from October 1, 2017, to September 30, 2020. Adjusted risk ratios (aRR) were estimated from multivariable logistic regressions. The analytic sample comprised 6,493 patients (mean age = 71 years (SD 15), 50% female, 37% Black, 9% Medicaid). Ten percent had an ED return within 30 days and almost half (43%) of patients had 7-day early follow-up. Patients with early follow-up had lower risk of ED returns (aRR 0.85 [95%CI, 0.71–0.98]). Regarding rates of early follow-up, there was no overall adjusted association with Black race, but the following variables were related to lower follow-up: Medicaid insurance (aRR 0.90 [95%CI, 0.80–1.00]), dialysis (aRR 0.86 [95%CI, 0.77–0.96]), depression (aRR 0.92 [95%CI, 0.86–0.98]), and discharged with opioids (aRR 0.94 [95%CI, 0.88–1.00]). When considering a hospital-level interaction, three of the 13 sites with the lowest percentage of Black patients had lower rates of early follow-up in Black patients (ranging from 15% to 55% reduced likelihood). Early follow-up visits were associated with a lower likelihood of ED returns for HF patients. Despite this potentially protective association, certain patient factors were associated with being less likely to receive scheduled follow-up visits. Hospitals with lower percentages of Black patients had lower rates of early follow-up for Black patients. Together, these may represent missed opportunities to intervene in high-risk groups to prevent ED returns in patients with HF.

Background We conducted a systematic review of studies published in peer-reviewed journals on HIV screening programs conducted in pediatric emergency departments (PEDs) in the United States (US) with the objective of describing the methods, testing yields and challenges in these programs. Methods We searched for full-text, English-language, original research articles focused on the conduct, development, initiation or implementation of any HIV screening program in a US PED through eight online databases (Pubmed (MEDLINE), Scopus, Embase, Cochrane, Web of Science, CINAHL, PsycInfo and Google Scholar) from their inception through July 2020. We also searched for articles on the websites of thirteen emergency medicine journals, 24 pediatric and adolescent health journals, and ten HIV research journals, and using the references of articles found through these searches. Data on HIV testing program components and yield of testing was extracted by one investigator independently and verified by a second investigator. Each program was summarized and critiqued. Results Of the eight articles that met inclusion criteria, most involved descriptions of their HIV testing program, except for one that was focused on quality improvement of their program. Five described an opt-in and three an opt-out approach to HIV screening. Programs differed greatly by type of HIV test utilized and who initiated or performed testing. There were large variations in the percentage of patients offered (4.0% to 96.7%) and accepting (42.7% to 86.7%) HIV testing, and HIV seropositivity in the studies ranged from 0 to 0.6%. Five of the eight studies reported an HIV seropositivity greater than 0.1%, above Centers for Disease Control and Prevention recommended threshold for testing in a healthcare setting. Conclusions The studies illustrate opportunities to further optimize the integration of HIV screening programs within US PEDs and reduce barriers to testing, improve efficiency of testing results and increase effectiveness of programs to identify cases. Future research should focus on advancing the methodology of screening programs beyond feasibility studies as well as conducting investigations on their implementation and longer-term sustainability.

Introduction: Physicians and other healthcare professionals have critical expertise and important experiences to help shape public policy, yet, historically, have been less likely to engage in the political process as measured by their propensity to vote. We examine whether previous trends in low physician voter turnout persist, contrasting to similar occupational groups and the general population. Methods: Data were from the 2004-2018 Current Population Survey (CPS) November Voter Supplement, a biennial nationally representative household survey that collects self-reported or reports by proxy (household member) voting rates and behavior from congressional and presidential elections. We identified five representative healthcare professionals (physicians, dentists, pharmacists, registered nurses, physician assistants) and five other comparison professions (postsecondary teachers, chief executives, civil engineers, social workers, lawyers) selected by similarities in income or educational backgrounds. Adjusted risk ratios (aRR) were estimated from multivariable logistic regressions comparing voting rates and behavior across occupations controlling for the year and sociodemographic characteristics associated with voting. Results: The pooled sample of US citizens age 18 and older (N=750,236) included 3,009 physicians, mean age 47.6 (SD, 14.9) years, 33.5% women. Household-level response rates ranged from 84%-92%. Physicians and other healthcare providers were significantly less likely to vote than comparison professions or the public after controlling for characteristics associated with voting. Compared to the public, adjusted physician voting rates were 12% lower than expected: aRR of 0.88 (95% confidence interval [CI], 0.83- 0.92) whereas comparison professions all demonstrated significantly higher voting rates, with postsecondary teachers showing the highest rates, aRR 1.18 (1.14-1.21). Physicians were 30% more likely to vote by mail, aRR 1.32 (1.12-1.42), and 15% more likely to vote before election day, aRR 1.15 (1.06- 1.25). Physicians who did not vote or register were 70% more likely to report this was due to being “Too busy, conflicting work or school,” compared to the public, aRR 1.7 (1.36 -1.96). Conclusion: Over 2004-2018, adjusted analysis find physicians and other healthcare professionals were significantly less likely to vote, whereas comparative professions were more likely to vote than the general public. Physicians were more likely to vote using alternatives to poll-based voting (voting early, vote by mail) and more likely to miss voting and registration due to work conflicts.

Background: Containment of the coronavirus disease 2019 (COVID-19) pandemic requires the public to change behavior under social distancing mandates. Social media are important information dissemination platforms that can augment traditional channels communicating public health recommendations. The objective of the study is to assess the effectiveness of COVID-19 public health messaging on Twitter when delivered by emergency physicians and containing personal narratives. Methods: On April 30, 2020, we randomly assigned 2007 U.S. adults to an online survey using a 2x2 factorial design. Participants rated 1 of 4 simulated Twitter posts varied by messenger type (emergency physician vs federal official) and content (personal narrative vs impersonal guidance). Main outcomes were: perceived message effectiveness (35-point scale); perceived attitude effectiveness (15-point scale); likelihood to share Tweets (7-point scale); and writing a letter to their governor to continue COVID-19 restrictions (write letter or none).Results: The physician/personal message had the strongest effect and significantly improved all main messaging outcomes except for letter-writing. Unadjusted mean differences between physician/personal and federal/impersonal were: perceived messaging effectiveness (3.2 [95%CI, 2.4-4.0]); perceived attitude effectiveness (1.3 [95%CI, 0.8-1.7]); likelihood to share (0.4 [95%CI, 0.15-0.7]). For letter-writing, physician/ personal made no significant impact compared to federal/ impersonal (odds ratio 1.14 [95%CI, 0.89-1.46]). Conclusions: Emergency physicians sharing personal narratives on Twitter are perceived to be more effective at communicating COVID-19 health recommendations compared to federal officials sharing impersonal guidance.

Importance Women and black physicians encounter workplace challenges because of their gender and race. It is unclear whether these individuals are assessed with lower patient satisfaction or confidence ratings compared with white male physicians. Objective To examine whether physician gender and race affect participant ratings in scenarios in which physician competence is challenged. Design, Setting, and Participants This randomized trial enrolled a geographically diverse sample of 3592 online respondents in the United States who were recruited from 2 crowdsourcing platforms: Amazon Mechanical Turk (n = 1741) and Lucid (n = 1851). A 2 × 2 factorial design for the gender and race of simulated physicians was conducted between March 9 and July 25, 2018. Participants were excluded before intervention if they were younger than 18 years, were pregnant, or had a history of cancer or abdominal surgical procedures. Interventions A clinical vignette was presented to the participant with a picture of the emergency department physician. Participants were randomly assigned to physicians with different gender and race, with 823 assigned to black women, 791 to black men, 828 to white women, and 835 to white men. A contradictory diagnosis from an online symptom checker introduced doubt about the clinical diagnosis. Main Outcomes and Measures A composite outcome (range, 0-100, with 0 representing low patient confidence and satisfaction and 100 representing the maximum on the composite scale) measured participant (1) confidence in the physician, (2) satisfaction with care, (3) likelihood to recommend the physician, (4) trust in the physician’s diagnosis, and (5) likelihood to request additional tests. Results Among 3277 adult participants, complete data were available for 3215 (median age, 49 years [range, 18-89 years]; 1667 [52%] female; 2433 [76%] white). No significant differences were observed in participant satisfaction and physician confidence for the white male physician control physicians (mean composite score, 66.13 [95% CI, 64.76-67.51]) compared with white female (mean composite score, 66.50 [95% CI, 65.19-67.82]), black female (mean composite score, 67.36 [95% CI, 66.03-68.69]), and black male (mean composite score, 66.96 [95% CI, 65.55-68.36]) physicians. Machine learning with bayesian additive regression trees revealed no evidence of treatment effect heterogeneity as a function of participants’ race, gender, racial prejudice, or sexism. Conclusions and Relevance No significant differences were observed for simulated patients’ evaluations of female or black physicians, suggesting that bias in favor of white male physicians is negligible in survey-based measures of patient satisfaction. Trial Registration ClinicalTrials.gov Identifier:NCT04190901