P006: Time for a national conversation: Practices and perspectives on HIV testing in Canadian emergency departments

Introduction: Improved access to HIV testing would benefit the one in six Canadians living with undiagnosed HIV, and potentially reduce transmission. Emergency departments may be the first or only point of contact with the healthcare system for people exposed to HIV; however, HIV testing remains inaccessible in many EDs in Canada. Methods: We used a grounded theory approach to characterize the experiences and context of HIV testing in Canadian EDs. We conducted semi-structured phone interviews with ED and public health practitioners from a purposive sample of urban, rural, academic, and community ED catchment areas. Thematic analysis was performed through iterative readings by two authors. Results were triangulated through consultation with public health and HIV experts. Results: Data were obtained from 16 ED physicians and 8 public health practitioners. HIV tests were infrequently performed in the EDs of our sample. Informants from higher incidence regions believed that greater availability of HIV tests in the ED would benefit the populations they serve. In half of the sample, rapid HIV tests were available. However, indications for testing were most often occupational or known high-risk exposure. Notably, two urban EDs in British Columbia screened all patients who otherwise needed blood tests (opt-out), but had shifted to opt-in testing at the time of this study. Consent practices and perceived requirements varied widely between sites; this confused or frustrated physicians. Most EDs were unable to offer a test result to patients during their visit as results were not available until days to weeks later. Commonly, the ordering physician was responsible for communicating results. Some EDs had an assigned physician managing all results on a given day while others relied on public health units for follow-up. All EDs reported access to public health clinics for ongoing care. Barriers to offering a test in the ED included time required for consent, discomfort with pre-test counselling, delay in results availability and unclear processes for follow-up. Conclusion: We describe substantial regional and within-site variation in HIV testing practices across a diverse sample of EDs across Canada. These findings highlight disparities in access to HIV testing and warrant a national discussion on best practices for testing in EDs with an emphasis on reducing barriers for high-risk populations and addressing unmet needs.

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Extending the Reach of Pediatric Emergency Preparedness: A Virtual Tabletop Exercise Targeting Children’s Needs

Public Health Reports ◽

10.1177/0033354919849880 ◽

2019 ◽

Vol 134 (4) ◽

pp. 344-353 ◽

Cited By ~ 1

Author(s):

Marvin So ◽

Eric J. Dziuban ◽

Jessica L. Franks ◽

Karen Cobham-Owens ◽

David J. Schonfeld ◽

...

Keyword(s):

Public Health ◽

Emergency Preparedness ◽

Interprofessional Collaboration ◽

Pediatric Emergency ◽

Health Practitioners ◽

Before And After ◽

Planning Capacity ◽

Public Health Practitioners

Objectives: Virtual tabletop exercises (VTTXs) simulate disaster scenarios to help participants improve their emergency-planning capacity. The objectives of our study were to (1) evaluate the effectiveness of a VTTX in improving preparedness capabilities specific to children’s needs among pediatricians and public health practitioners, (2) document follow-up actions, and (3) identify exercise strengths and weaknesses. Methods: In February 2017, we conducted and evaluated a VTTX facilitated via videoconferencing among 26 pediatricians and public health practitioners from 4 states. Using a mixed-methods design, we assessed participants’ knowledge and confidence to fulfill targeted federal preparedness capabilities immediately before and after the exercise. We also evaluated the degree to which participants made progress on actions through surveys 1 month (n = 14) and 6 months (n = 14) after the exercise. Results: Participants reported a greater ability to identify their state’s pediatric emergency preparedness strengths and weaknesses after the exercise (16 of 18) compared with before the exercise (10 of 18). We also observed increases in (1) knowledge of and confidence in performing most pediatric emergency preparedness capabilities and (2) most dimensions of interprofessional collaboration. From 1 month to 6 months after the exercise, participants (n = 14) self-reported making progress in increasing awareness for potential preparedness partners and in conducting similar pediatric exercises (from 4-7 for both). Conclusions: Participants viewed the VTTX positively and indicated increased pediatric emergency preparedness knowledge and confidence. Addressing barriers to improving local pediatric emergency preparedness—particularly long term—is an important target for future tabletop exercises.

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Public Health Surveillance and the Opioid Crisis

A Public Health Guide to Ending the Opioid Epidemic ◽

10.1093/oso/9780190056810.003.0021 ◽

2019 ◽

pp. 253-264

Author(s):

Jeffrey P. Engel ◽

Valerie N. Goodson ◽

Megan Toe ◽

Michael Landen

Keyword(s):

Public Health ◽

Disease Surveillance ◽

Public Health Surveillance ◽

Health Surveillance ◽

Opioid Epidemic ◽

Infectious Disease Surveillance ◽

Health Practitioners ◽

Public Health Practitioners ◽

Case Based

The roles for public health surveillance are well established in the infectious disease surveillance literature; however, as they relate to noninfectious diseases and more specifically the current opioid epidemic, there is little standardization between states on what is being surveilled and there is a lack of definitions for some of the most important elements of the crisis, such as what constitutes an overdose death from opioids. Without standard definitions and processes, public health practitioners may develop response protocols based on incomplete data. As such, the opioid epidemic presents many challenges for public health surveillance by limiting the ability for case-based follow-up and stymies creation of a variety of shared indicators and metrics that make it difficult to capture the true burden of disease. In this chapter, the authors review prior surveillance activities related to substance use and share emerging consensus on opportunities to improve the surveillance among states and territories.

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Putting skills into practice: Readiness for change among public health practitioners

PsycEXTRA Dataset ◽

10.1037/e508992013-078 ◽

2005 ◽

Author(s):

Ann Casebeer ◽

Gail MacKean ◽

Carla Troy ◽

Jennifer Sealy

Keyword(s):

Public Health ◽

Readiness For Change ◽

Health Practitioners ◽

Practice Readiness ◽

Public Health Practitioners

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Postpartum depression guidelines for public health practitioners: Putting primary health care into action

PsycEXTRA Dataset ◽

10.1037/e508992013-191 ◽

2005 ◽

Author(s):

Peggy Strass

Keyword(s):

Public Health ◽

Health Care ◽

Primary Health Care ◽

Postpartum Depression ◽

Primary Health ◽

Health Practitioners ◽

Public Health Practitioners

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Screening at ports of entry for Ebola Virus Disease in England—a descriptive analysis of screening assessment data, 2014–2015

Journal of Public Health ◽

10.1093/pubmed/fdaa216 ◽

2020 ◽

Author(s):

Nicki L Boddington ◽

Sophia Steinberger ◽

Richard G Pebody

Keyword(s):

Public Health ◽

High Risk ◽

Secondary Care ◽

Ebola Virus ◽

Virus Disease ◽

Descriptive Analysis ◽

Health Assessment ◽

Ebola Virus Disease ◽

Screening Assessment

Abstract Background In response to the outbreak of Ebola Virus Disease (EVD) in West Africa in 2014 and evidence of spread to other countries, pre-entry screening was introduced by PHE at five major ports of entry in the England. Methods All passengers that entered the England via the five ports returning from Liberia, Guinea and Sierra Leonne were required to complete a Health Assessment Form and have their temperature taken. The numbers, characteristics and outcomes of these passengers were analysed. Results Between 14 October 2014 and 13 October 2015, a total of 12 648 passengers from affected countries had been screened. The majority of passengers were assessed as having no direct contact with EVD cases or high-risk events (12 069, 95.4%), although 535 (4.2%) passengers were assessed as requiring public health follow-up. In total, 39 passengers were referred directly to secondary care, although none were diagnosed with EVD. One high-risk passenger was later referred to secondary care and diagnosed with EVD. Conclusions Collection of these screening data enabled timely monitoring of the numbers and characteristics of passengers screened for EVD, facilitated resourcing decisions and acted as a mechanism to inform passengers of the necessary public health actions.

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What makes a ‘successful’ collaborative research project between public health practitioners and academics? A mixed-methods review of funding applications submitted to a local intervention evaluation scheme

Health Research Policy and Systems ◽

10.1186/s12961-020-00671-0 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Peter van der Graaf ◽

Lindsay Blank ◽

Eleanor Holding ◽

Elizabeth Goyder

Keyword(s):

Public Health ◽

Health Research ◽

Collaborative Research ◽

Online Survey ◽

Public Health Practice ◽

Rapid Review ◽

Success Rates ◽

Evaluation Scheme ◽

Health Practitioners ◽

Public Health Practitioners

Abstract Background The national Public Health Practice Evaluation Scheme (PHPES) is a response-mode funded evaluation programme operated by the National Institute for Health Research School for Public Health Research (NIHR SPHR). The scheme enables public health professionals to work in partnership with SPHR researchers to conduct rigorous evaluations of their interventions. Our evaluation reviewed the learning from the first five years of PHPES (2013–2017) and how this was used to implement a revised scheme within the School. Methods We conducted a rapid review of applications and reports from 81 PHPES projects and sampled eight projects (including unfunded) to interview one researcher and one practitioner involved in each sampled project (n = 16) in order to identify factors that influence success of applications and effective delivery and dissemination of evaluations. Findings from the review and interviews were tested in an online survey with practitioners (applicants), researchers (principal investigators [PIs]) and PHPES panel members (n = 19) to explore the relative importance of these factors. Findings from the survey were synthesised and discussed for implications at a national workshop with wider stakeholders, including public members (n = 20). Results Strengths: PHPES provides much needed resources for evaluation which often are not available locally, and produces useful evidence to understand where a programme is not delivering, which can be used to formatively develop interventions. Weaknesses: Objectives of PHPES were too narrowly focused on (cost-)effectiveness of interventions, while practitioners also valued implementation studies and process evaluations. Opportunities: PHPES provided opportunities for novel/promising but less developed ideas. More funded time to develop a protocol and ensure feasibility of the intervention prior to application could increase intervention delivery success rates. Threats: There can be tensions between researchers and practitioners, for example, on the need to show the 'success’ of the intervention, on the use of existing research evidence, and the importance of generalisability of findings and of generating peer-reviewed publications. Conclusions The success of collaborative research projects between public health practitioners (PHP) and researchers can be improved by funders being mindful of tensions related to (1) the scope of collaborations, (2) local versus national impact, and (3) increasing inequalities in access to funding. Our study and comparisons with related funding schemes demonstrate how these tensions can be successfully resolved.

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After Action Review of the 2019 measles outbreak in Clark County, Washington, U.S.A

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.598 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Stoto ◽

R Piltch-Loeb ◽

R Wolfe ◽

R Albrandt ◽

A Melnick

Keyword(s):

Public Health ◽

Religious Community ◽

Local Health ◽

Mutual Aid ◽

Social Distancing ◽

Clark County ◽

After Action Review ◽

Measles Outbreak ◽

Health Practitioners ◽

Public Health Practitioners

Abstract Issue Clark County experienced a measles outbreak that challenged public health authorities. Description of the practice: We conducted a formal After Action Review with state and local health officials, school officials, and others to identify lessons for public health practitioners facing future outbreaks. Results Following the early identification of measles in a child who had recently arrived from Ukraine, active surveillance identified 71 confirmed cases, most in unvaccinated persons under 18 years of age. 4,138 contacts were traced and public health personnel made daily monitoring calls to 816. 53 potential exposure sites in healthcare facilities, schools and other public places were identified and communicated to the public. As a social distancing measure, unvaccinated students, teachers, and staff were excluded from schools in which exposure had occurred. Ascertaining susceptibility status was challenging. The national anti-vaccination sentiment and a parallel outbreak in a New York religious community created challenges in representing community risk while avoiding stigmatization of a community in which the first reported case was identified. Rather than respond to every false claim on social media, the health department developed talking points about emerging issues and engaged the community in dialogue. Lessons Responding to the measles outbreak required innovative approaches to surveillance and contact tracing, social distancing (school exclusions), and emergency risk communication. The response required extensive coordinated efforts of the county and state health departments, school systems, and many other organizations. Mutual aid enabled an influx of resources but managing the surge of responders proved challenging. Key messages Public health emergencies require effective emergency management practices. Carefully conducted After Action Reviews of health emergencies can help public health practitioners identify challenges and innovative practices.

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