Brief intervention with peer recovery coach support has been used to generate referrals to substance use disorder treatment from the emergency department (ED). This retrospective study evaluated factors associated with successful linkage to treatment following brief intervention in the ED.Data were extracted from the electronic health record for patients who were referred to substance use treatment from the ED and for whom follow-up data regarding treatment attendance was available (n=666). We examined associations between demographic and insurance variables, substance use, mental health diagnosis, prior abstinence, and stage of change with successful linkage to substance use treatment after ED referral.The sample was majority male (68%), White (62%), and had a mean age of 43 years (SD=12). Medicaid was the most common insurance (49%) followed by employer/private (34%). Multivariable logistic regression determined patients with Medicaid (OR=2.94, 95% CI:2.09-4.13, p=<.001), those who had a documented alcohol use disorder diagnosis (OR=1.59, 95% CI:1.074-2.342, p=.02), and those in the "Action" stage of change (OR=2.33, 95% CI:1.47-3.69, p=<.001) had greater odds of being successfully linked to treatment.These results identify characteristics of patients available in the health record to determine who is more likely or less likely to attend substance use treatment following ED referral. Given appropriate screening, this information could be used to direct standard care resources to those with high likelihood of treatment attendance and strengthen follow-up interventions with peer recovery coaches for those with lower likelihood of treatment attendance. 

https://doi.org/10.1016/j.dadr.2022.100093

Factors related to substance use treatment attendance after peer recovery coach intervention in the emergency department

Excessive drinking accounts for more than 95,000 deaths annually in the United States. Coronavirus disease 2019 (COVID-19) pandemic-related factors (e.g., social, economic, policy) may have affected alcohol consumption. Emergency department (ED) visits involving acute alcohol consumption (referred to as "alcohol-related") are a useful indicator for assessing changes in alcohol-related harms.The 2018-2020 National Syndromic Surveillance Program data, which include nonfatal ED visits from facilities in 49 states and Washington, DC, were analyzed. Trends in the number of alcohol-related ED visits among people ≥15 years, and weekly alcohol-related ED visit rates (per 10,000 total visits) overall, by demographic characteristics, and quarter (Q) were assessed. Quarterly rates for 2018 and 2019 were averaged to increase baseline data stability.Alcohol-related visits accounted for 1.6% of 60,474,770 total visits (2018), 1.7% of 61,564,380 total visits (2019), and 1.8% of 52,174,507 total visits (2020). The number of alcohol-related ED visits generally increased during the first eight months of 2018 and 2019. However, it sharply declined at the onset of the COVID-19 pandemic in mid-March-mid-April 2020, before resuming pre-pandemic patterns. Alcohol-related ED visits per 10,000 were higher during quarters in 2020 than corresponding quarters in 2018-2019 (Q1: +7.3%, Q2: +23.8%, Q3: +9.7%, Q4: +6.5%).Alcohol-related ED visit rates per 10,000 total visits increased during 2020 versus 2018-2019, with the greatest relative difference in the second quarter. Fewer people sought ED care in 2020 than 2018-2019 but alcohol-related visits declined to a lesser extent than total visits. 

https://doi.org/10.1016/j.dadr.2022.100049

Trends in emergency department visits related to acute alcohol consumption before and during the COVID-19 pandemic in the United States, 2018–2020

Key Points Question Is a brief automated bilingual computerized alcohol screening and intervention (AB-CASI) health information technology tool superior to standard care in reducing alcohol consumption and alcohol-related adverse health behaviors and consequences among US Latino emergency department (ED) patients? Findings In this randomized clinical trial of 840 self-identified adult Latino ED patients with unhealthy drinking, the number of binge drinking episodes within the last 28 days was significantly lower in the AB-CASI group compared with the standard care group (3.2 episodes vs 4.0; 7.7 episodes at baseline in both groups) at 12 months after randomization. Meaning These findings suggest that AB-CASI is a viable approach to addressing alcohol-related health disparities in the ED, a setting that serves as a national health care front line and safety net.

https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2805167/vaca_2023_oi_230459_1683899138.40032.pdf

Use of an Automated Bilingual Digital Health Tool to Reduce Unhealthy Alcohol Use Among Latino Emergency Department Patients

Background: Substance abuse has become a serious issue that is faced by the world. The effects of drug abuse can be detrimental to corporeal, psychological and societal well-being of a person. Drug misuse is actually unrestrained habit of drugs leading to inspiration of reward-system in brain Substance abuse also influences the food preferences and dietary habits of the users, therefore affecting the person’s nutrition. Instead of how frequently a person engages in the behavior, substance abuse and substance addiction are distinguished by how challenging it is for the person to manage without the behavior or quit it for a specific period of time.  Methodology: Electronic databases were used to conduct a thorough, systematic analysis of research, which was restricted to those with English/English abstracts and used words like "addiction," "nutrition," "lifestyle," "alcohol," "reward system," "recreational substances," etc., Conclusion: An effort has been made in this research article to highlight the effects of various addictive substances on different systems in human body with the role of adequate nutrition to fight back this addiction for the overall betterment of the society.

Nutrition and addiction - are they linked in de-addictive process?

Background Poor glycemic control is one of the most determinant factors for type 2 diabetes-related morbidity and mortality. The proportion of type 2 diabetes mellitus patients with poor glycemic control remains high. Yet evidence on factors contributing to poor glycemic control remains scarce. The aim of this study is to identify determinants of poor glycemic control among type 2 diabetes mellitus patients at a diabetes mellitus clinic in University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia Determinants of Poor Glycemic Control among Type 2 Diabetes mellitus Patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: Unmatched Case-Control Study Methods A hospital-based case-control study was conducted from June to September 2020. Using convenience sampling techniques, a total of 90 cases and 90 controls with type 2 diabetes were recruited. The data were entered into Epidata version 4.6.0.2 and analyzed by Stata version 14. A multivariable logistic regression analysis was performed to assess the association between independent variables and glycemic control. Both 95% CI and p-value<0.05 were used to determine the level and significance, respectively. Results The mean age ( ± standard deviations) for the cases and controls were 57.55± 10.42 and 61.03± 8.93% respectively. The determinants of poor glycemic control were age (Adjusted odd ratio (AOR)= 0.08; 95% CI= 0.02-0.33), inadequate physical exercise (AOR = 5.05; 95% CI = 1.99-11.98), presence of comorbidities (AOR = 5.50; 95% CI = 2.06-14.66), non-adherence to anti-diabetes medications (AOR= 2.76; 95% CI= 1.19-6.40), persistent proteinuria (AOR=4.95; 95% CI=1.83-13.36) and high-density lipoprotein less than 40 mg/dl (AOR=3.08; 95% CI= 1.30-7.31). Conclusions Age less than 65 years, inadequate physical exercise, presence of comorbidities, non-adherence to anti-diabetes medications, persistent proteinuria, and high-density lipoprotein less than 40 mg/dl were the determinants of poor glycemic control. Therefore, targeted educational and behavioral modification programs on adequate exercise and medication adherence should be routinely practiced. Furthermore, early guideline-based screening and treatment of comorbidities and complications is required to effectively manage diabetes mellitus.

/pdf/determinants-of-poor-glycemic-control-among-type-2-diabetes-2rfiuyo2.pdf

Determinants of poor glycemic control among type 2 diabetes mellitus patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: Unmatched case-control study

Objective To assess current screening practices for excessive alcohol consumption, as well as perceived barriers, perceptions, and attitudes toward performing this screening among emergency department (ED) physicians. Design A brief online assessment of screening practices for excessive drinking was disseminated electronically to a representative panel of ED physicians from November 2016 to January 2017. Descriptive statistics were calculated on the frequency of alcohol screening, factors affecting screening, and attitudes toward screening. Setting An online assessment was sent to a national panel of ED physicians. Participants A panel of ED physicians who volunteered to be part of the American College of Emergency Physicians Emergency Medicine Practice Research Network survey panel. Main outcome measure The primary outcome measures were the percentage of respondents who reported screening for excessive alcohol consumption and the percentage of respondents using a validated excessive alcohol consumption screening tool. Results Of the 347 ED physicians evaluated (38.6% response rate), approximately 16% reported "always/usually," 70% "sometimes," and 14% "never" screening adult patients (≥18 years) for excessive alcohol use. Less than 20% of the respondents who screened for excessive drinking used a recommended screening tool. Only 10.5% of all respondents (15.4% "always," 9.5% "sometimes" screened) received an electronic health record (EHR) reminder to screen for excessive alcohol use. Key barriers to screening included limited time (66.2%) and treatment options for patients with drinking problems (43.1%). Conclusions Only 1 in 6 ED physicians consistently screened their patients for excessive drinking. Increased use of EHR reminders and other systems interventions (eg, electronic screening and brief intervention) could help improve the delivery of screening and follow-up services for excessive drinkers in EDs.

Kari M Gloppen

Papers

Screening for Excessive Alcohol Consumption in Emergency Departments: A Nationwide Assessment of Emergency Department Physicians.