Depression is associated with repeat emergency department visits in patients with non-specific abdominal pain

Introduction: Patients with abdominal pain often return multiple times despite no definitive diagnosis. Our objective was to determine if repeat emergency department (ED) use among patients with non-specific abdominal pain might be associated with a diagnosis of moderate to severe depressive disorder. Methods: We screened 987 ED patients for major depression during weekday daytime hours from June 2011 through November 2011 using a validated depression screening tool, the PHQ-9. Each subject was classified as either no depression, mild depression or moderate/ severe depression based on the screening tool. Within this group, we identified 83 patients with non-specific abdominal pain by either primary or secondary diagnosis. Comparing depressed patients versus non-depressed patients, we analyzed demographic characteristics and number of prior ED visits in the past year. Results:In patients with non-specific abdominal pain, 61.9% of patients with moderate or severe depression (PHQ9≥10) had at least one visit to our ED for the same complaint within a 365-day period, as compared to 29.2% of patients with no depression (PHQ9 Conclusion: Repeat ED use among patients with non-specific abdominal pain is associated with moderate to severe depressive disorder. Patients with multiple visits for abdominal pain may benefit from targeted ED screening for depression. [West J Emerg Med. 2014;15(3):325–328.

The Summit on Creativity and Aging in America

This report looks at how the federal government can leverage the arts to foster healthy aging and inclusive design for this growing population. This white paper features recommendations from the May 2015 Summit on Creativity and Aging in America, a convening of more than 70 experts hosted by the National Endowment for the Arts and the National Center for Creative Aging. The paper highlights recommendations on healthy aging, lifelong learning in the arts, and age-friendly community design. The summit was a precursor to the 2015 White House Conference on Aging, which addressed four major issues: retirement security, long-term services and supports, healthy aging, and elder abuse

Access to Urgent Pediatric Primary Care Appointments in the District of Columbia

Background Timely access to acute primary care appointments after an emergency department (ED) visit has become a challenge for both providers and patients. Previous studies have documented disparities in accessing adult primary care and pediatric specialty care, especially among those lacking private insurance. There is little data regarding urgent pediatric primary care access. Concerns over pediatric provider access need to be addressed as public and private insurance expansions begin within health reform. Objective This study measured pediatric access to urgent primary care appointments within the District of Columbia (D.C.) following an ED visit. We hypothesized there would be a disparity in access for uninsured children or those with Medicaid. Methods We used mystery caller methodology to evaluate rates of appointment access for pediatric patients. Calls were made to randomly selected private pediatric practices as well as pediatricians at safety net clinics. Research assistants posed as a parent calling to secure an urgent appointment for their child following a recent ED visit for urinary tract infection symptoms using a standardized clinical script that varied by insurance status. We calculated rates of appointment success as well as average length of time between call date and appointment date. All appointments were canceled prior to termination of the call. We analyzed differences in appointment success rates and wait times using bivariate chi2 analysis. Results We sampled 57 safety net clinics and 29 private clinics. Although the results were not statistically significant (p=0.55), successful appointment rates were the lowest among Medicaid (27.8%) callers attempting to make appointments at private clinics. Calls made to safety net providers for the Medicaid patient scenario (48.8%, p=0.38) or uninsured patient scenario (47.7%, p=0.42) had the highest appointment success rate however had longer wait times. The average appointment wait time at safety net clinics for Medicaid patients was 12.3 days (95% CI, 3.5 to 21.1) and 10.4 days (95% CI, 6.7 to 14.1) for uninsured patients. Average appointment wait times for private patients at private practices were 1.9 days (95% CI, 1.0 to 2.7). Conclusion This study did document a disparity in access to urgent pediatric primary care appointments between callers with different types of health insurance in D.C. Although appointment success rates were not different by practice setting or insurance type, average appointment wait times were significantly longer for callers to safety net providers than private practices. Public policies that improve the capacity of pediatric safety net providers and clinics are necessary to improve access

Stakeholders\u27 Perceptions of a Hospital Based Emergency Medicine Education & Training Program: A System Change

Background: Emergency Medicine (EM) is a new and developing specialty around the world. In India, one model for capacity building has been the development of partnerships between US academic institutions and private healthcare institutions for implementing post-graduate education and training in EM. Initiated in 2007, programs have grown both in number and scope and have continued to attract new students and partner institutions. This study was undertaken to better understand the impact of EM training programs on hospital systems. Methods: A mixed-methods evaluation was undertaken at 5 program sites across India in the summer of 2016. Two researchers conducted onsite semi-structured interviews with key program stakeholders. Participants included hospital administrators, program directors, hospital consultants, and ancillary staff at each hospital. Interviews were recorded, transcribed and then analyzed using a rapid assessment process. Participants also completed a brief survey. Written surveys were analyzed with univariate analysis. Results: A total of 109 stakeholders were interviewed. Positive impacts were reported among all stakeholders, particularly among administrators, consultants, ancillary staff, and supervising physicians in the ED. 80% of hospital administrators and 90% of direct ED supervisors report improved quality of care particularly among critically ill patients. Some respondents, including 89% of administrators, attributed increased patient volumes at least in part due to the educational program. Of respondents, non-ED consultants were less likely to report improvement in quality during off-service rotations, but 92% reported improved patient care in the hospital related to the program. Positive impacts extended beyond the hospital with many examples of community outreach, layperson education, and improved hospital reputation. Discussion: Evaluation of a changing system of emergency care has proven challenging to study. These data reflect substantial impacts to a hospital and the surrounding system after development of an EM training program, extending beyond the hospital itself to community outreach programs and a wide variety of education and training programs. Further investigation may prove helpful in quantifying the reported improvement in quality and scope of impact

Depression Is Associated with Repeat Emergency Department Visits in Patients with Non-specific Abdominal Pain

Introduction: Patients with abdominal pain often return multiple times despite no definitive diagnosis. Our objective was to determine if repeat emergency department (ED) use among patients with non-specific abdominal pain might be associated with a diagnosis of moderate to severe depressive disorder.Methods: We screened 987 ED patients for major depression during weekday daytime hours from June 2011 through November 2011 using a validated depression screening tool, the PHQ-9. Each subject was classified as either no depression, mild depression or moderate/ severe depression based on the screening tool. Within this group, we identified 83 patients with non-specific abdominal pain by either primary or secondary diagnosis. Comparing depressed patients versus non-depressed patients, we analyzed demographic characteristics and number of prior ED visits in the past year.Results: In patients with non-specific abdominal pain, 61.9% of patients with moderate or severe depression (PHQ9≥10) had at least one visit to our ED for the same complaint within a 365-day period, as compared to 29.2% of patients with no depression (PHQ9<5), (p=0.013).Conclusion: Repeat ED use among patients with non-specific abdominal pain is associated with moderate to severe depressive disorder. Patients with multiple visits for abdominal pain may benefit from targeted ED screening for depression. [West J Emerg Med. 2014;15(3):325–328.

Reflect and Reset: Black Academic Voices Call the Graduate Medical Education Community to Action

The COVID-19 pandemic highlighted the great achievements that the biomedical community can accomplish, but raised the question: Can the same medical community that developed a complex vaccine in less than a year during a pandemic, help to defeat social injustice and ameliorate the epidemic of health inequity? In this perspective, the authors, a group of Black academics, call on the graduate medical education (GME) community to reset its trajectory toward solutions for achieving diversity, improving inclusion, and combating racism using education as the new vector. Sponsoring institutions, which include universities, academic medical centers, teaching hospitals, and teaching health centers, are the center of the creation and dissemination of scholarship. They are often the main sources of care for many historically marginalized communities. The GME learning environment must provide the next generation of medical professionals with an understanding of how racism continues to have a destructive influence on health care professionals and their patients. Residents have the practical experience of longitudinal patient care, and a significant portion of an individual\u27s professional identity is formed during GME; therefore, this is a key time to address explicit stereotyping and to identify implicit bias at the individual level. The authors propose three main reset strategies for GME-incorporating inclusive pedagogy and structural competency into education, building a diverse and inclusive learning environment, and activating community investment-as well as tactics that sponsoring institutions can adapt to address racism at the individual learner, medical education program, and institutional levels. Sustained, comprehensive, and systematic implementation of multiple tactics could make a significant impact. It is an academic and moral imperative for the medical community to contribute to the design and implementation of solutions that directly address racism, shifting how resident physicians are educated and modelling just and inclusive behaviors for the next generation of medical leaders

Why Emergency Physicians Should Advocate for Suspension of Title 42 Restrictions on Asylum for US Immigrants

Despite its purpose as a public health measure, Title 42 has been implemented as a tool for immigration policy. It has not provided control for the COVID-19 pandemic. Instead, it has caused harm to vulnerable migrant populations and to our emergency departments. Emergency physicians should advocate its suspension