Emergency department screening for latent tuberculosis infection.

OBJECTIVE: Approximately 12.4 million people in the U.S. have latent tuberculosis infection (LTBI), 73% of whom are non-U.S. born. Identification and treatment of LTBI are essential for tuberculosis eradication. We evaluated an emergency department (ED) - based LTBI screening and linkage to care program. METHODS: We queried electronic records of a clinical prevention program located in a Midwestern, urban, academic ED that serves as the region's safety-net hospital. Program staff approached non-U.S. born ED patients from TB endemic areas. Patients received QuantiFERON-TB Gold Plus (QFT) blood testing and, if positive, were referred to treatment. The primary outcome was the proportion of tested patients newly diagnosed with LTBI. We secondarily report the number of patients linked to care who initiated LTBI treatment. RESULTS: The program approached 33 patients, of whom 24 (72.7%) were eligible, and 23 (95.8%) were tested. The majority were male (13, 56.5%), median age was 33 years (IQR 27-45), and 13 (56.5%) were from Latin America. Three patients (13.0%, 95% CI 0.03-0.35) were newly diagnosed with LTBI and linked to care; two (66.7%) started LTBI treatment. CONCLUSIONS: In this first report of an ED-based LTBI screening program implemented in a region with low TB prevalence, over 10% of high-risk ED patients tested positive for LTBI and were linked to treatment. Screening populations at risk for LTBI in EDs and linking them to public health treatment services should be prioritized in order to achieve TB elimination in the U.S.

Patient motivators to use opioids for acute pain after emergency care.

Introduction: Patients are stakeholders in their own pain management. Factors motivating individuals to seek or use opioids therapeutically for treatment of acute pain are not well characterized but could be targeted to reduce incident iatrogenic opioid use disorder (OUD). Emergency departments (EDs) commonly encounter patients in acute pain for whom decisions regarding opioid therapy are required. Decision-making is necessarily challenged in episodic, unscheduled care settings given time pressure, limited information, and lack of pre-existing patient provider relationship. Patients may decline to take prescribed opioids or conversely seek opioids from other providers or non-medical sources. Methods: Using a framework analysis approach, we qualitatively analyzed transcripts from 29 patients after discharge from an ED visit for acute pain at a large, urban, academic hospital in the midwestern United States to describe motivating factors influencing patient decisions regarding opioid use for acute pain. A semi-structured interview guide framed participant discussion in either a focus group or interview transcribed and analyzed with conventional content analysis. Results: Four major themes emerged from our analysis including a) pain management literacy, b) control preferences, c) risk tolerance, and d) cues to action. Discussion: Our findings suggest targets for future intervention development and a framework to guide the engagement of patients as stakeholders in their own acute pain management.