Social emergency medicine

Background

Organizing framework which recognizes that social, economic, environmental, and legal issues play a large part in health outcomes
In the emergency department, downstream effects of these social determinants of health are seen on a daily basis and ED serves important role as a social safety net
Goals include integrating consideration of social influences to help improve population health and potentially improve costs of emergency care^[1]

Areas of Focus

Homelessness/unstable housing^[2]^[3]
Hunger^[4]
Substance abuse
Community violence
Guns and public health^[5]^[6]^[7]
Domestic or intimate partner violence
Chronic diseases such as HIV, hepatitis C
Human trafficking

Aims

Encourage and promote research, with aim of developing useful interventions
- A research agenda should emphasize the potential for expanding the role of the ED as a site of public and population health research and intervention, extend the surveillance and data collection capacity of the ED, and increase research on the cost-effectiveness of a diverse array of preventive services^[1]
Integration of social determinants of health into medical school and residency training
Community and legislative advocacy

Interventions

Screening, brief intervention and referral to treatment (SBIRT) for patients dealing with substance abuse ^[8]^[9]^[10]^[11]
Medication assisted treatment (MAT) in the ED for opioid abuse^[12]
Public health screening
- HIV, Hepatitis C^[13]^[14]^[15]^[16]
Help desks/Advocate programs - help connect patients with key community resources
Medical-Legal Partnerships
Housing first
- Housing First initiatives are shown to be cost-effective mainly by cost savings through decreased health care use^[17]^[18]
California Frequent Users of Health Services Initiative
Street Medicine Programs

Education

Resident Bedside Teaching: IDHEAL Modules

Fellowships

Stanford Social Emergency Medicine Fellowship

UCLA International and Domestic Health Equity Fellowship

Cambridge Health Alliance/Harvard Health Equity, Policy and Leadership Fellowship

External Links

References

↑ ^1.0 ^1.1 Anderson ES, Hsieh D, Alter HJ. Social Emergency Medicine: Embracing the Dual Role of the Emergency Department in Acute Care and Population Health. Ann Em Med. 2016; 68(1):21-25.
↑ InsKushel, M.B., Perry, S., Bangsberg, D. et al. Emergency department use among the homeless and marginally housed: results from a community-based study. Am J Public Health. 2002; 92: 778–784ert footnote text here
↑ Feldman BJ, Calogero CG, Elsayed KS, et al. Prevalence of Homelessness in the Emergency Department Setting. Western Journal of Emergency Medicine. 2017;18(3):366-372. doi:10.5811/westjem.2017.1.33054.
↑ Seligman HK, Laraia BA, Kushel MB. Food insecurity is associated with chronic disease among low income NHANES participants. J Nutr. 2010 Feb:140(2): 304-310
↑ Ranney ML, Fletcher J, Alter H, et al. A Consensus-Driven Agenda for Emergency Medicine Firearm Injury Prevention Research. Ann Emerg Med 2016 Dec 18.
↑ Newgard C, Kuppermann N, Holmes JF, Haukoos J, Wetzel B, Hsia R, Wang NE, Bulger EM, Staudenmayer K, Mann NC, Barton E, Wintemute GJ. Gunshot Injuries in Children Served by Emergency Services Compared with Other Injury Mechanisms. Pediatrics. Nov;132(5):862-70.
↑ Long-term mortality of patients surviving firearm violence. Academic Journal. Fahimi, J, Anderson, E, Schnorr, CD, Alter, HJ, Larimer, E, Hamud-Ahmed, W, Yen, I. Inj Prev. Apr 2016, 22(2):129-134.
↑ Bernstein, S.L., Bijur, P., Cooperman, N. et al. A randomized trial of a multicomponent cessation strategy for emergency department smokers. Acad Emerg Med. 2011; 18: 575–583
↑ D'Onofrio, G., Fiellin, D.A., Pantalon, M.V. et al. A brief intervention reduces hazardous and harmful drinking in emergency department patients. Ann Emerg Med. 2012; 60: 181–192
↑ Bernstein, S.L. and D'Onofrio, G. A promising approach for emergency departments to care for patients with substance use and behavioral disorders. Health Aff (Millwood). 2013; 32: 2122–2128
↑ Bernstein, E., Bernstein, J., Feldman, J. et al. An evidence based alcohol screening, brief intervention and referral to treatment (SBIRT) curriculum for emergency department (ED) providers improves skills and utilization. Substance Abuse. 2007; 28: 79–92
↑ D’Onofrio G, O’Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, Bernstein SL, Fiellin DA. Emergency Department–Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence: A Randomized Clinical Trial. JAMA. 2015;313(16):1636–1644.
↑ Paltiel, A.D., Weinstein, M.C., Kimmel, A.D. et al. Expanded screening for HIV in the United States—an analysis of cost-effectiveness. N Engl J Med. 2005; 352: 586–595
↑ Silva, A., Glick, N.R., Lyss, S.B. et al. Implementing an HIV and sexually transmitted disease screening program in an emergency department. Ann Emerg Med. 2007; 49: 564–572
↑ Sanders, G.D., Bayoumi, A.M., Sundaram, V. et al. Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy. N Engl J Med. 2005; 352: 570–585
↑ Anderson, E.S., Pfeil, S.K., Deering, L.J., Todorovic, T., Lippert, S. and White, D.A., High-impact hepatitis C virus testing for injection drug users in an urban ED. The American Journal of Emergency Medicine, 2016; 34(6), pp.1108-1111.
↑ Doran, K.M., Ragins, K.T., Gross, C.P. et al. Medical respite programs for homeless patients: a systematic review. J Health Care Poor Underserved. 2013; 24: 499–524
↑ Larimer, M.E., Malone, D.K., Garner, M.D. et al. Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems. JAMA. 2009; 301: 1349–1357

Authors:

[ann-1] 1.0 ^1.1 Anderson ES, Hsieh D, Alter HJ. Social Emergency Medicine: Embracing the Dual Role of the Emergency Department in Acute Care and Population Health. Ann Em Med. 2016; 68(1):21-25.

[2] InsKushel, M.B., Perry, S., Bangsberg, D. et al. Emergency department use among the homeless and marginally housed: results from a community-based study. Am J Public Health. 2002; 92: 778–784ert footnote text here

[3] Feldman BJ, Calogero CG, Elsayed KS, et al. Prevalence of Homelessness in the Emergency Department Setting. Western Journal of Emergency Medicine. 2017;18(3):366-372. doi:10.5811/westjem.2017.1.33054.

[4] Seligman HK, Laraia BA, Kushel MB. Food insecurity is associated with chronic disease among low income NHANES participants. J Nutr. 2010 Feb:140(2): 304-310

[5] Ranney ML, Fletcher J, Alter H, et al. A Consensus-Driven Agenda for Emergency Medicine Firearm Injury Prevention Research. Ann Emerg Med 2016 Dec 18.

[6] Newgard C, Kuppermann N, Holmes JF, Haukoos J, Wetzel B, Hsia R, Wang NE, Bulger EM, Staudenmayer K, Mann NC, Barton E, Wintemute GJ. Gunshot Injuries in Children Served by Emergency Services Compared with Other Injury Mechanisms. Pediatrics. Nov;132(5):862-70.

[7] Long-term mortality of patients surviving firearm violence. Academic Journal. Fahimi, J, Anderson, E, Schnorr, CD, Alter, HJ, Larimer, E, Hamud-Ahmed, W, Yen, I. Inj Prev. Apr 2016, 22(2):129-134.

[8] Bernstein, S.L., Bijur, P., Cooperman, N. et al. A randomized trial of a multicomponent cessation strategy for emergency department smokers. Acad Emerg Med. 2011; 18: 575–583

[9] D'Onofrio, G., Fiellin, D.A., Pantalon, M.V. et al. A brief intervention reduces hazardous and harmful drinking in emergency department patients. Ann Emerg Med. 2012; 60: 181–192

[10] Bernstein, S.L. and D'Onofrio, G. A promising approach for emergency departments to care for patients with substance use and behavioral disorders. Health Aff (Millwood). 2013; 32: 2122–2128

[11] Bernstein, E., Bernstein, J., Feldman, J. et al. An evidence based alcohol screening, brief intervention and referral to treatment (SBIRT) curriculum for emergency department (ED) providers improves skills and utilization. Substance Abuse. 2007; 28: 79–92

[12] D’Onofrio G, O’Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, Bernstein SL, Fiellin DA. Emergency Department–Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence: A Randomized Clinical Trial. JAMA. 2015;313(16):1636–1644.

[13] Paltiel, A.D., Weinstein, M.C., Kimmel, A.D. et al. Expanded screening for HIV in the United States—an analysis of cost-effectiveness. N Engl J Med. 2005; 352: 586–595

[14] Silva, A., Glick, N.R., Lyss, S.B. et al. Implementing an HIV and sexually transmitted disease screening program in an emergency department. Ann Emerg Med. 2007; 49: 564–572

[15] Sanders, G.D., Bayoumi, A.M., Sundaram, V. et al. Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy. N Engl J Med. 2005; 352: 570–585

[16] Anderson, E.S., Pfeil, S.K., Deering, L.J., Todorovic, T., Lippert, S. and White, D.A., High-impact hepatitis C virus testing for injection drug users in an urban ED. The American Journal of Emergency Medicine, 2016; 34(6), pp.1108-1111.

[17] Doran, K.M., Ragins, K.T., Gross, C.P. et al. Medical respite programs for homeless patients: a systematic review. J Health Care Poor Underserved. 2013; 24: 499–524

[18] Larimer, M.E., Malone, D.K., Garner, M.D. et al. Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems. JAMA. 2009; 301: 1349–1357

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