Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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This article provides recommendations for incorporating conceptual models of health behavior change into research conducted in emergency care settings. The authors drafted a set of preliminary recommendations, which were reviewed and discussed by a panel of experienced investigators attending the 2009 Academic Emergency Medicine consensus conference. ⋯ Three recommendations were made: 1) research conducted in emergency care settings that focuses on health behaviors should be grounded in formal conceptual models, 2) investigators should clearly operationalize their outcomes of interest, and 3) expected relations between theoretical constructs and outcomes should be made explicit prior to initiating a study. A priori hypothesis generation grounded in conceptual models of health behavior, followed by empirical validation of these hypotheses, is needed to improve preventive and public health-related interventions in emergency care settings.
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This article summarizes a panel discussion on "SBIRT in the emergency care setting: are we ready to take it to scale?" Dr. Edward Bernstein commented on the historical developments of emergency department (ED) screening, brief intervention (BI), and referral to treatment (SBIRT) research, practice, and knowledge translation. ⋯ Dr. Richard Saitz reviewed the limitations of the evidence for alcohol and drug ED screening and BI and cautioned on the danger of proceeding to practice and broad dissemination without evidenced based on randomized controlled trials with sufficient sample size and clinically important outcomes.
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This article describes a limited statewide dissemination of an evidence-based technology, screening, brief intervention, and referral to treatment (SBIRT), and evaluation of the effects on emergency department (ED) systems of care, utilizing the knowledge translation framework of reach, effectiveness, adoption, implementation, and maintenance (RE-AIM), using both quantitative and qualitative data sources. Screening and brief intervention (SBI) can detect high-risk and dependent alcohol and drug use in the medical setting, provide early intervention, facilitate access to specialty treatment when appropriate, and improve quality of care. Several meta-analyses demonstrate its effectiveness in primary care, and the federal government has developed a well-funded campaign to promote physician training and adoption of SBI. ⋯ Five of seven sites were sustained through the second year of the program, despite cutbacks in state funding. The dissemination process provided a number of important lessons for a large rollout. Successful implementation of the ED-SBIRT HPA model depends on 1) external funding for start-up; 2) local ED staff acting as champions to support the HPA role, resolve territorial issues, and promote a cultural shift in the ED treatment of drug and alcohol misuse from "treat and street" to prevention, based on a knowledge of the science of addiction; 3) sustainability planning from the beginning involving administrators, the billing and information technology departments, medical records coders, community service providers, and government agencies; and 4) creation and maintenance of a robust referral network to facilitate patient acceptance and access to substance abuse services.
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The burden of mental illness is profound and growing. Coupled with large gaps in extant psychiatric services, this mental health burden has often forced emergency departments (EDs) to become the de facto primary and acute care provider of mental health care in the United States. An expanded emergency medical and mental health research agenda is required to meet the need for improved education, screening, surveillance, and ED-initiated interventions for mental health problems. ⋯ Research that optimizes provider education and training can help academic settings validate psychosocial issues as core components and responsibilities of emergency medicine. Transdisciplinary research with federal partners and investigators in neuropsychiatry and related fields can improve the mechanistic understanding of acute mental health problems. To have lasting impact, however, advances in ED mental health care must be translated into real-world policies and sustainable program enhancements to assure the uptake of best practices for ED screening, treatment, and management of mental disorders and psychosocial problems.
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This article summarizes the work and discussions of the funding and sustainability work group at the 2009 Academic Emergency Medicine consensus conference "Public Health in the ED: Surveillance, Screening, and Intervention." The funding and sustainability session participants were asked to address the following overarching question: "What are the opportunities and what is needed to encourage academic emergency medicine (EM) to take advantage of the opportunities for funding available for public health research initiatives and build stronger academic programs focusing on public health within EM?" Prior to the session, members of the group reviewed research funding for EM in public health, as well as the priorities of federal agencies and foundations. Recommendations for actions by EM summarize the findings of workshop.