North Carolina Medical Journal最新文献

Background: Few data describing prehospital pediatric substance misuse exist. The objective of this study was to characterize substance misuse in North Carolina pediatric patients receiving emergency medical services (EMS) care.

Methods: We conducted a retrospective cross-sectional study of patients aged < 16 years transported by EMS for substance misuse. Data were obtained from a statewide repository including patients treated for confirmed or suspected misuse of marijuana, alcohol, benzodiazepines, opioids, stimulants, acetaminophen, antidepressants, or other drugs.

Results: Of 45,855 EMS encounters, 448 patients misused drugs. Most patients were female (56.7%), White (50.9%), adolescent (73.8%), and resided in Central North Carolina (54.0%). A plurality of cases was rural (46.2%), followed by urban (27.9%) and regional city/suburban counties (25.7%). Calls most often originated in residential locations (68.5%). Drugs identified during EMS calls included alcohol (24.2%), marijuana (24.2%), benzodiazepines (8.8%), antidepressants (8.8%), stimulants (6.8%), opioids (5.9%), and other medications (17.6%). Motivations for drug use were recreational (58.4%), self-harm (24.6%), and accidental (17.0%).

Limitations: Due to insufficient data documentation, one EMS system was removed from analysis. Additionally, misclassification of type of drug or intention of drug use is possible due to the use of free-text patient narratives.

Conclusions: EMS responded to a vast variety of drug misuse among pediatric patients including prescription medications, alcohol, marijuana, and illicit drugs. Accidental ingestions occurred exclusively in infant/preschool ages and intent for recreation or self-harm primarily occurred in adolescents. By increasing awareness of the more common pediatric patient characteristics associated with the type and reason for drug use, EMS agencies can improve pediatric readiness among prehospital clinicians.

At a time when most of our headlines focus on overdoses and overdose-related deaths, recovery is possible. Treatment courts are providing a path toward recovery and healing.

Background: There has been a growing interest in integrating social and function-focused care into health care settings. Little is known about what older adults perceive as the needs that impact their lives, and the resources to address patients' social and functional needs often exist outside of traditional health care settings.

Methods: Our objective was to understand frail older adults' and community organizations' perspectives on what social and functional needs impact older adults' health, the support they receive, and how organizations and health systems could partner to address these needs. We conducted semi-structured interviews with patients and community-based organizations. Patients were aged 65 years or older, frail (electronic frailty index greater than 0.21), and at an increased geographic risk of unmet social needs (Area Deprivation Index greater than or equal to the 75th percentile). Staff were from organizations that provided social and/or functional resources to older adults. We used an inductive content analysis approach and the constant comparative method to analyze the data and identify themes.

Results: We interviewed 23 patients and 28 staff from 22 distinct organizations. We found that social, financial, and functional needs were common and highly intertwined among older adults with frailty, but the support they received at home, from their health care providers, and from community organizations was highly varied.

Limitations: Our sample was limited to participants from one county, so the results may not be generalizable to other areas. We only inter-viewed organizations and patients with frailty.

Conclusions: Health systems and community organizations have distinct areas of expertise, and purposeful collaboration between them could be important in addressing the needs of frail older adults.

I advocate for a "no wrong door" approach, which ensures that no matter where you enter the system-doctor, therapist, family-referral, self-report, jail, hospital, etc. -you get the treatment that gives you the best chance at long-term recovery, even if you don't have M.D. after your name.

Physician Health Programs (PHPs) have been support-ing and advocating for health professionals for nearly four decades. Initially developed by state medical societies in the 1980s, PHPs recognized the need for therapeutic alterna-tives to disciplinary measures for physicians facing health issues that could impair their ability to practice safely. Originally focused on substance use disorders, PHPs have since expanded their services to encompass mental health and other co-occurring conditions.

Almost 12 people in North Carolina die each day from a drug overdose. Primary care providers are ill-equipped to screen, diagnose, and treat substance use disorders. We must see the humanity in all patients and build a better understand-ing of the root causes of, and truly effective solutions for, addiction.

Background: Individuals who gave birth from May 2021 through July 2021 at Atrium Health Wake Forest Baptist (AHWFB) Hospital were surveyed to identify barriers to prenatal care (PNC), assess adequacy of PNC, and examine how these measures relate to race, ethnicity, and income.

Methods: A survey was administered to 200 individuals giving birth at AHWFB. Eligibility included English- or Spanish-speaking, aged 18 years or older, and a gestational age of 35 weeks or greater at delivery. Primary outcomes included PNC receipt and PNC barriers. Stratification by race, ethnicity, and income were also evaluated.

Results: PNC receipt rates were 81%, 87%, and 88% in the first 28 weeks, between 28 and 36 weeks, and after 36 weeks, respectively, with 76% of individuals receiving adequate PNC throughout pregnancy. Non-White or Hispanic participants experienced lower PNC rates in the first 28 weeks, and participants reporting an annual household income of less than $20,000 experienced lower PNC rates throughout pregnancy. While 19% of participants reported at least one barrier to PNC, the number of barriers reported did not differ based on race, ethnicity, or income. However, it was found that participants who reported at least one barrier were less likely to receive PNC throughout pregnancy.

Limitations: This study was limited by convenience sampling and the potential for recall bias. Conclusions: Although race, ethnicity, and income were not associated with the number of reported barriers, they did impact the likelihood of receiving adequate PNC. As self-reported race/ethnicity in our study likely served as a proxy for racism and race-based discrimination, future research should more formally investigate the role of structural racism in the receipt of PNC.

Dr. Rahul Gupta, the first practicing physician to serve as Director of the White House Office of National Drug Control Policy, shares his perspective on the national response to the opioid crisis and how North Carolina is poised to take action to save lives from overdose.