The impact of educational interventions on attitudes of emergency department staff towards patients with substance-related presentations: a quantitative systematic review

Interventions to reduce interpersonal stigma towards patients with a mental dysregulation for ambulance and emergency department healthcare professionals: review protocol for an integrative review

INTRODUCTION

Worldwide, there is an increase in the extent and severity of mental illness. Exacerbation of somatic complaints in this group of people can result in recurring ambulance and emergency department care. The care of patients with a mental dysregulation (ie, experiencing a mental health problem and disproportionate feelings like fear, anger, sadness or confusion, possibly with associated behaviours) can be complex and challenging in the emergency care context, possibly evoking a wide variety of feelings, ranging from worry or pity to annoyance and frustration in emergency care staff members. This in return may lead to stigma towards patients with a mental dysregulation seeking emergency care. Interventions have been developed impacting attitude and behaviour and minimising stigma held by healthcare professionals. However, these interventions are not explicitly aimed at the emergency care context nor do these represent perspectives of healthcare professionals working within this context. Therefore, the aim of the proposed review is to gain insight into interventions targeting healthcare professionals, which minimise stigma including beliefs, attitudes and behaviour towards patients with a mental dysregulation within the emergency care context.

METHODS AND ANALYSIS

The protocol for a systematic integrative review is presented, using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols recommendations. A systematic search was performed on 13 July 2023. Study selection and data extraction will be performed by two independent reviewers. In each step, an expert with lived experience will comment on process and results. Software applications RefWorks-ProQuest, Rayyan and ATLAS.ti will be used to enhance the quality of the review and transparency of process and results.

ETHICS AND DISSEMINATION

No ethical approval or safety considerations are required for this review. The proposed review will be submitted to a relevant international journal. Results will be presented at relevant medical scientific conferences.

PROSPERO REGISTRATION NUMBER

CRD42023390664 (https://www.crd.york.ac.uk/prospero/).

Factors influencing medical students' attitudes towards substance use during pregnancy

BACKGROUND

People with substance use disorder, and pregnant women especially, are subject to a lot of stigmas, which can prevent optimal accessibility and quality of care. In this survey, we investigated attitudes of final year medical students regarding substance use during pregnancy and identified the factors that influence these attitudes.

METHOD

This cross-sectional study was conducted in 2019 and 2020 in Belgium using the short version of the "Substance Abuse Attitude Survey" questionnaire. We focused on two items regarding punishment of substance use during pregnancy. We analysed the concordance between these two, their correlation with other items (e.g. stereotyping, morality, forced withdrawal, low treatment optimism) and the association between respondents' opinion on punishment and their sociodemographic data.

RESULTS

The response rate was 65.2% (370/567 online and face-to face questionnaires). 19.2% of respondents were in favour of punishment for alcohol use (n = 353) and 15.1% for drug use (n = 356) during pregnancy. The agreement analysis between the two items showed that 14.3% of students were in favour of punishing both pregnant women who use drugs and those using alcohol. Respondents tended to be more in favour of punishment if they were male students, older, their mothers' had a lower education level or had no personal or family history of substance use. Attitudes appeared to be more punitive among students with limited contact with people with substance use disorder (i.e. none or limited to hospital). Students intending to specialise in internal medicine were more in favour of punishment of women whereas none of those intending to specialise in psychiatry were in favour.

CONCLUSION

Our study shows that about 20% of surveyed medical students favoured punishing substance-using pregnant women. Awareness and training work seems to be necessary to ensure adequate care and support for this already vulnerable population.

Do adolescents and young adults accessing the Emergency Room with substance use receive poor therapeutic indications at discharge? An observational retrospective study

PURPOSE

Emergency rooms (ERs) are usually the first point of contact with mental health services for adolescents with Substance Use Disorders (SUDs). However, only a minority of them receives proper treatment and follow-up indications, increasing the risk of relapses and poor prognosis. In this perspective, we sought to characterize and compare socio-demographic and clinical characteristics of adolescents with vs without SUDs accessing the ER, assessing potential differences in terms of discharge instructions.

METHODS

A sample of 557 ER accesses of patients aged 15-25 years old in need of a psychiatric evaluation or with a psychiatric diagnosis at discharge was retrospectively analyzed. Patients were divided in two subgroups according to the presence of SUDs.

RESULTS

About 32.1% of patients had SUDs when accessing the ER. Among these, 62% were unknown to any psychiatric services and 57% were at their psychiatric onset. Nevertheless, considering discharge instructions, patients with current substance use received less therapeutic indication or were less frequently referred to psychiatric facilities, than those without substance use (57.8% vs 42.2%, P = .002).

CONCLUSIONS

Substance abuse is strongly linked to psychopathology and ER accesses in young patients. However, we observed a large rate of SUDs patients unknown by any specialized mental health service, who received poor therapeutic and follow-up instructions at discharge. Improving communication between ER operators and young patients with SUDs could longitudinally reduce the risk of addiction and related disability, morbidity and mortality.

A Syringe Service Program Within a Federal System: Foundations for Implementation

BACKGROUND

Drug use, specifically opioid use, is a public health crisis in the United States. Harm reduction programs, including syringe service programs, show efficacy in improving individual and public health outcomes. Healthcare provider perceptions are an important initial assessment when considering implementing a syringe service program.

OBJECTIVE

The objective of this quality improvement project, completed in a Northeastern Veterans Affairs Medical Center (NEVAMC), was to lay the groundwork for implementation of a syringe service program.

METHODS

This multiphase project included an initial needs assessment with stakeholders to determine the scope of substance use disorder within the facility and initiated the change process needed for syringe service program implementation. We administered an online survey, the Drug and Drug Problems Perceptions Questionnaire (DDPPQ), to better understand staff perspectives of and comfort in working with people who use drugs. Two educational modules were developed and conducted for staff to increase their knowledge, skills, and trauma-informed practices when working with people who use drugs. Standardized document templates for program implementation in federal systems were also developed.

RESULTS

The needs assessment identified 266 patients who could benefit from expanded harm reduction services and a recognition that staff perception be assessed within the facility. The DDPPQ, completed by 153 staff members, indicated positive perceptions of people who use drugs and ability to counsel/treat people who use drugs. The median DDPPQ total score was 73, indicative of an overall positive perception. Sixty-eight staff members attended the initial education session, and 35 attended the second session designed specifically for mental health service line professionals.

CONCLUSION

The findings indicate NEVAMC staff members have a high level of comfort working with people who use drugs. The staff educational programs were well received and have become a part of routine staff training at the NEVAMC. The standardized document templates are available for persons developing a syringe service program within a federal system.

Intoxicated persons showing challenging behavior demand complexity interventions: a pilot study at the interface of the ER and the complexity intervention unit

Intoxicated persons showing challenging behavior (IPCBs) under influence of alcohol and/or drugs frequently have trouble finding appropriate acute care. Often IPCBs are stigmatized being unwilling or unable to accept help. Separated physical and mental healthcare systems hamper integrated acute care for IPCBs. This pilot aimed to substantiate the physical, psychiatric, and social health needs of IPCBs visiting the emergency room (ER) during a 3-month period. All ER visits were screened. After triage by the ER physician, indicated IPCBs were additionally assessed by the consultation-liaison-psychiatry physician. If needed, IPCBs were admitted to a complexity intervention unit for further examinations to provide integrated treatments and appropriate follow-up care. The INTERMED and Health of the Nation Outcome Scale (HoNOS) questionnaires were used to substantiate the complexity and needs. Field-relevant stakeholders were interviewed about this approach for acute integrated care. Alongside substance abuse, almost half of identified IPCBs suffered from comorbid psychiatric disturbances and one third showed substantial physical conditions requiring immediate medical intervention. Almost all IPCBs (96%) accepted the acute medical care voluntarily. IPCBs showed high mean initial scores of INTERMED (27.8 ± 10.0) and HoNOS (20.8 ± 6.9). At discharge from the complexity intervention unit, the mean HoNOS score decreased significantly (13.4 ± 8.6; P < 0.001). Field-relevant stakeholders strongly supported the interdisciplinary approach and ER-facility for IPCBs and acknowledged their unmet health needs. A biopsychosocial assessment at the ER, followed by a short admission if necessary, is effective in IPCBs. This approach helps to merge separated healthcare systems and may reduce stigmatization of IPCBs needing help.