Karin Verlaine Rhodes

The objective of this study was to measure the efficacy of protection orders (POs) in reducing assault and injury-related outcomes using a matched comparison group and tracking outcomes over time. This study was a retrospective review of police, emergency department, family court, and prosecutor administrative records for a cohort of police-involved female IPV victims; all events over a 4-year study period were abstracted. Victims who obtained POs were compared with a propensity-score-based match group without POs over three time periods: Before, During, and After the issuance of a PO. Having a PO in place was associated with significantly more calls to police for nonassaultive incidents and more police charging requests that were of multiple-count and felony-level. Comparing outcomes, PO victims had police incident rates that were more than double the matched group prior to the PO but dropped to the level of the matched group during and after the order. ED visits dropped over time for both groups. This study confirmed the protective effect of POs, which are associated with reduced police incidents and emergency department visits both during and after the order and reduced police incidents compared with a matched comparison group.

Research from JAMA Pediatrics — Academic Medical Centers and Equity in Specialty Care Access for Children

Letter from JAMA Pediatrics — Access to Autism Evaluation Appointments With Developmental-Behavioral and Neurodevelopmental Subspecialists

Health care reform has expanded eligibility to public insurance without fully addressing concerns about access. We measured children's access to outpatient specialty care to identify disparities in providers' acceptance of Medicaid and the Children's Health Insurance Program (CHIP) versus private insurance.

This article examines associations between cumulative adverse fnancial circumstances and patient health in a sample of 1,506 urban emergency department (ED) patients. Study participants completed a previously validated Social Health Survey between May and October 2009. Five categories of economic deprivation were studied: food insecurity, housing concerns, employment concerns, cost-related medication nonadherence, and cost barriers to accessing physician care. Logistic regression that adjusted for the effects of demographics (age, gender, race, education) tested the association between the cumulative number of adverse fnancial circumstances (range: 0 to 5) and patients' health status (self-rated health, stress level, depressed mood) and health behaviors (smoking and substance abuse). Approximately 48 percent of respondents reported one or more fnancial concern, and 31 percent reported two or more fnancial concerns. A signifcant graded relationship was found between the number of adverse fnancial circumstances and patients' poor/fair self-rated health, depressed mood, high stress, smoking, and illicit drug use. Findings suggest that in today's acute health safety net, patients' concerns related to fnancial insecurity are very relevant to patient health. This underscores the imperative for hospital-based social workers to design models of routine social health risk screening and system interventions that address patient fnancial well-being in the ED.

While victims of intimate partner violence (IPV) present to health care settings for a variety of complaints; rates and predictors of case identification and intervention are unknown.

ACADEMIC EMERGENCY MEDICINE 2011; 18:267–272 © 2011 by the Society for Academic Emergency Medicine Objectives: There has been a rapid rise in prescription drug costs over the past decade. As a result, many Americans are unable to afford their medications, especially in the current economic recession. Medication nonadherence is known to have adverse effects on health outcomes. The purpose of this study was to gain a preliminary understanding of cost‐related medication nonadherence (CRMN) disclosure among screened emergency department (ED) patients and to describe the extent to which CRMN is associated with other economic and psychosocial risk factors.Methods: This was a prospective, cross‐sectional study of a convenience sample of adult patients presenting to an urban academic ED with 61,962 annual visits in 2009. Nonemergent patients received an optional self‐administered Social Health Survey between May and October 2009. Results were assessed from the sample of anonymous surveys that were completed and collected. Standard statistical methods were used to determine the frequencies and relative risks (RRs) for CRMN with 95% confidence intervals (CIs).Results: A total of 384 (25.5%) of the 1,506 adult patients who completed the survey either screened positive for any prior CRMN (20.7%) or disclosed concerns about affording medication (4.8%). Patients were significantly more likely to report risk for CRMN if they used tobacco (RR = 1.8, 95% CI = 1.5 to 2.2) or illicit drugs (RR = 2.0, 95% CI = 1.6 to 2.4), experienced intimate partner violence (IPV; RR = 1.8, 95% CI = 1.5 to 2.2), or reported concerns about overall financial instability (RR = 3.9, 95% CI = 3.2 to 4.7), food insufficiency (RR = 3.7, 95% CI = 3.1 to 4.3), housing problems (RR = 2.5, 95% CI = 2.1 to 2.9), and inadequate health insurance coverage (RR = 7.7, 95% CI = 6.2 to 9.5).Conclusions: Risk for medication nonadherence due to cost concerns was identified in a quarter of nonemergent urban ED patients in our sample and was more likely to be reported by patients experiencing other economic and psychosocial risks. These findings indicate a need to include discussions about medication affordability and referrals to social services as part of ED discharge planning.