Opportunities for intervention: Characteristics of alcohol related visits to United States emergency departments, 2003 - 2007

The cycle of alcohol intoxicated patients passing through United States (US) emergency departments (ED) and repeated inpatient detoxification for alcohol inebriates is costly, as these patients are continually exposed to injury and other health and legal consequences of their continued at risk alcohol use. The high proportion of ED resources used by these alcohol intoxicated patients has contributed to increased patient wait times, increased ambulance diversions, forced closures of US EDs, increased numbers of patients leaving without being seen, and an overall reduction in the quality of medical services provided in the ED. In order to contribute to efforts towards reducing the proportion of ED visits which involve hazardous alcohol consumption, this project used a national probabilistic sample of emergency department patient visits to demonstrate and quantify: 1) the burden that alcohol use and abuse places on EDs in the US; 2) the particular service needs of patients presenting for alcohol intoxication; 3) the degree to which ED clinicians refer patients with alcohol related diagnoses to treatment geared towards at risk alcohol consumption; and 4) trends in rates of hospitalizations for alcohol related visits over the study period. Alcohol related and non-alcohol related visits were compared using national ED data to measure the impact of alcohol related visits on the emergency medical service delivery system. Using cross-sectional data from the 2003 - 2007 National Hospital Ambulatory Medical Care Survey (NHAMCS), patients were assigned to alcohol related and non-alcohol related categories using physician diagnoses. These diagnoses, present in the NHAMCS data are coded using the International Classification of Disease Ninth Revision - Clinical Modification (ICD9-CM). Once identified, patients seen for alcohol related visits were compared to patients seen for non-alcohol related visits. Weighted visit characteristics were compared with odds ratios (OR), t-tests and 95% confidence intervals (CI). Of 575 million weighted ED visits, 1.62% were for alcohol related conditions. This translated to an average annual rate of 1,619.6 alcohol related visits per 100,000 ED admissions. No temporal trends in the rate of visits per 100,000 ED admissions were observed during the study period. Alcohol related visits took longer (1,254.2 min vs. 892.6 min; p\u3c0.0001), were triaged with a higher level of acuity, and received more diagnostic tests (5.5 vs. 4.4; p\u3c0.0001). Patients seen for alcohol related conditions were more apt to have been seen in the last 72 hours and had more visits to the same ED within the last year (2.6 visits vs. 1.5 visits, p=0.0028). Alcohol related patients more frequently arrived at the ED via ambulance (51.6% vs. 16.3%; OR 5.2, 95% CI 4.7-5.5) or via public services (9.4% vs. 1.5%, OR 7.0, 95% CI 5.6-8.8). Alcohol related patients were more often male (71% vs. 46%; OR 3.0, 95% CI 1.9-2.3), aged 25-44 years (44.6% vs. 28.7%; OR 2.0, 95% CI 1.8-2.2), and homeless (13.5% vs. 0.5%; OR 5.7, 95% CI 3.9-8.3). The primary payer source was self-pay (31.6% vs. 15.1%; OR 2.6, 95% CI 2.4-2.9). Alcohol related patients were more apt to be injured (97.2% vs. 34.7%; OR 64.5, 95% CI 45.61-91.4). Alcohol related patients were more likely to become injured due to assault (6.9% vs. 4.4%, OR 1.6, 95% CI 1.3-1.9) and unintentional injury (51.7% vs. 26.7%, OR 1.6, 95% CI 1.5-1.9) than patients without alcohol diagnoses. Alcohol related patients were more often admitted to a hospital (7.9% vs. 12.8%; OR1.4, 95% CI 1.2-1.6) or to leave the ED against medical advice (3.2% vs. 1.1%; OR 3.1, 95% CI 2.3-4.2). Patients discharged from the ED were referred to alcohol treatment only 18.5% of the time. Patients presenting with alcohol related conditions were more frequently referred to social services (7.4% vs. 0.7%, OR 12.1, 95% CI 9.0-16.4). Only 47.8% of all alcohol related visits required medical treatment beyond alcohol detoxification. Patients presenting to the ED with alcohol related medical conditions use more resources, have longer ED visits, and infrequently receive referral to substance abuse treatment. High priority should be placed on methods to identify patients who could safely be managed in sobering facilities. Indicated interventions with measured levels of success in reducing the frequency of alcohol related visits to the ED such as the Screening and Brief Intervention with Referral to Treatment (SBIRT) program must be employed. SBIRT has performed well in clinical evaluation for reducing alcohol related visits to US EDs

Evaluating the impact of social determinants on pedestrian injury in Clark County, Nevada

In order to understand the social determinants which may impact pedestrian injury rates in an urban, sprawling, western community we conducted an ecologic investigation to compare pedestrian crash rates by social determinants available for census tracts in Clark County, NV

Indigenous Health – Australia, Canada, New Zealand and the United States - Laying Claim to a Future that Embraces Health for Us All.

Improving the health of all peoples has been a call across the globe for many decades and unfortunately remains relevant today, particularly given the large disparities in health status of peoples found around the world. Rather than differences in health, or health inequalities, we use a different term, health inequities. This is so as mere differences in health (or inequalities ) can be common in societies and do not necessarily reflect unfair social policies or practices. For example, natural ageing implies older people are more prone to illness. Yet, when differences are systematic, socially produced and unfair, these are considered health inequities. Certainly making judgments on what is systematic, socially produced and unfair, reflects value judgments and merit open debate. We are making explicit in this paper what our judgments are, and the basis for these judgment

Injury in Nevada

Injury is a major threat to health and safety. In a typical day in the US, 400 people will die as the result of an injury, 7,500 will be hospitalized due to an injury, and more than 150,000 will suffer an injury severe enough to restrict activities and seek medical attention. Many of these deaths, hospitalizations, and disabling events will be the result of motor vehicle crashes. Others will result from vio­lence, falls, drowning, and poisoning – all of which are considered injuries. The costs of injury are high. In the United States, the cost of injuries is estimated to be $200 billion a year. In addition to the rising costs of emergency care, hospitalization, rehabilitation and disability services there is also a high human cost for victims, families, and communities. Beyond the medical ex­penses, since a majority of injury victims are younger, there are the costs of lost wages and productivity, reduced quality of life, and the years of potential life lost for those who die from their injuries. It is impossible to calculate the emotional and social damage to individu­als, families, and communities when lives are changed by injury. Injuries are preventable. Injuries are not random, unavoidable occurrences; they can be understood and prevented. Injury preven­tion is now an important part of public health practice and strategies for prevention are prominent in the health goals for the nation. To achieve these goals and prevent injury, we need to understand when and where injuries occur, identify modifiable risk factors, and implement and evaluate intervention and prevention strategies. Our best strategies are education, technology and engineering, and enforcing what works. Good data and involvement from many sectors of the com­munity are essential for success. In Nevada, injury is a leading cause of death for children, teens and young adults. With high rates of motor vehicle crash rates, high suicide rates, and workplace injury rates, Nevada must be proactive in understanding and preventing injuries. The good news is, the available data and information can tell us a lot about injury in Nevada and there are people across the state working hard on pre­vention. This report presents the results of a statewide project to identify data, programs, and people working to keep Nevadans safe and healthy

Indigenous health - Australia, Canada, Aotearoa New Zealand, and the United States - laying claim to a future that embraces health for us all: world health report (2010) background paper, no 33

[extract] Improving the health of all peoples has been a call across the globe for many decades and unfortunately remains an elusive goal today as the large disparities in health status of peoples found around the world have not diminished, and have arguably increased. Rather than referring to absolute differences in health, or health inequalities, we use a different term throughout this paper. We use the term health inequities because mere differences in health (or inequalities ) can be common in societies and do not necessarily reflect unfair social policies or practices. Report reproduced with the permission of the publisher

Indigenous Health: Australia, Canada, Aotearoa, New Zealand and the United States: Laying Claim to a Future that Embraces Health for Us All

World Health Report (2010) Background Paper, No 33. Improving the health of all peoples has been a call across the globe for many decades and unfortunately remains an elusive goal today as the large disparities in health status of peoples found around the world have not diminished, and have arguably increased. Rather than referring to absolute differences in health, or health inequalities, we use a different term throughout this paper. We use the term health inequities because mere differences in health (or "inequalities") can be common in societies and do not necessarily reflect unfair social policies or practices. For example, natural ageing implies older people are more prone to illness - this paper does not review in detail the biologically driven health inequalities that exist, we focus instead on socially driven inequities. Yet, when differences are systematic, socially produced and unfair, these are considered health inequities. Certainly making judgments on what is systematic, socially produced and unfair, reflects value judgments and merits open debate. We are making explicit in this paper what our judgments are, and the basis for these judgments to facilitate scrutiny and debate. The World Health Assembly in 2009 (WHO 2009) passed a resolution endorsed by each of its 193 Member States - that reducing health inequities within and across countries should be a priority for all countries and development partners