Svetla Slavova

Drug Overdose Deaths: Let's Get Specific:

Oregon Public Health Division, Injury and Violence Prevention Program, Portland, ORAddress correspondence to: Svetla Slavova, PhD, University of Kentucky College of Public Health, Kentucky Injury Prevention and Research Center, 333 Waller Ave., Ste. 242, Lexington, KY 40504; tel. 859-323-7873; fax 859-257-3909; e-mail .©2015 Association of Schools and Programs of Public Health

Bridging the care continuum: patient information needs for specialist referrals

BackgroundInformation transfer is critical in the primary care to specialist referral process and has been examined extensively in the US and other countries, yet there has been little attention to the patients perspective of the information transfer process. This cross-sectional study examined the quality of the information received by patients with a chronic condition from the referring and specialist physician in the specialist referral process and the relationship of the quality of information received to trust in the physicians.MethodsStructured telephone interviews were conducted with a random sample of 250 patients who had experienced a referral to a specialist for the first visit for a chronic condition within the prior six months. The sample was selected from the patients who visited specialist physicians at any of the 500 hospitals from the National Research Corporation client base.ResultsMost patients (85%) received a good explanation about the reason for the specialist visit from the referring physician yet 26% felt unprepared about what to expect. Trust in the referring physician was highly associated with the preparatory information patients received. Specialists gave good explanations about diagnosis and treatment, but 26% of patients got no information about follow-up. Trust in the specialist correlated highly with good explanations of diagnosis, treatment, and self-management.ConclusionPreparatory information from referring physicians influences the quality of the referral process, the subsequent coordination of care, and trust in the physician. Changes in the health care system can improve the information transfer process and improve coordination of care for patients.

The effect of poison control center consultation on accidental poisoning inpatient hospitalizations with preexisting medical conditions.

In 2005, the Kentucky Poison Control Center (PCC) recorded 46,625 poisoning calls; 27% received hospital treatment. Probabilistic data linkage of accidental poisoning inpatient hospital (IPH) discharge data and PCC data (years 2000–2004) was performed. This study compared IPH with/without preexisting medical conditions and IPH with/without PCC consultation, examining total length of stay and total hospitalization charges. When compared to the IPH reference group with no preexisting medical conditions and who did not consult the PCC (mean charges =

Defining elements of success: a critical pathway of coalition development.

8748, mean length of stay = 3.2 d), PCC consultation without a preexisting medical condition was significantly associated with decreased total hospitalization charges and decreased length of stay (mean charges =

Heroin and fentanyl overdoses in Kentucky: Epidemiology and surveillance

4999, mean length of stay = 1.9 d). When the patient had a preexisting medical condition, PCC consultation was still associated with decreased total hospitalization charges and length of stay (mean charges =

Motor vehicle injuries among semi truck drivers and sleeper berth passengers

8145, mean length of stay = 2.4 d) compared to those patients with a preexisting medical condition who did not consult the PCC (mean charges =

Crash and burn? Vehicle, collision, and driver factors that influence motor vehicle collision fires

10,607, mean length of stay = 3.6 d). These results suggest that after accounting for a patients age and gender, consultation with the PCC is significantly associated with reduced total hospitalization charges and reduced length of stay for IPH, and this association holds for patients with and without a preexisting medical condition.

The Effects of Semi Truck Driver Age and Gender and the Presence of Passengers on Collisions with Other Vehicles

In recent decades, coalitions have been established to address many public health problems, including injury prevention. A partnership among the Kentucky Injury Prevention and Research Center and four injury prevention coalitions has documented the developmental stages of successful coalitions. This developmental process was constructed through the analysis of participating coalition documents, such as each coalitions mission statement, bylaws or rules of operation, the use of committees within the organization, frequency of meetings, and additional historical documents. Themes from this analysis guided researchers in designing a critical pathway model that describes milestones in coalition formation. Critical components in coalition formation include a clear definition of the coalition structure, coalition enhancement, funding, community support, leadership, education and outreach to the community, membership, partnerships, data and evaluation, and publicity. These findings are applicable to public health professionals who work with community-based coalitions and citizens who participate in local coalitions.

Concurrent alcohol and medication poisoning hospital admissions among older rural and urban residents

BACKGROUND The study aims to describe recent changes in Kentuckys drug overdose trends related to increased heroin and fentanyl involvement, and to discuss future directions for improved drug overdose surveillance. METHODS The study used multiple data sources (death certificates, postmortem toxicology results, emergency department [ED] records, law enforcement drug submissions, and prescription drug monitoring records) to describe temporal, geographic, and demographic changes in drug overdoses in Kentucky. RESULTS Fentanyl- and heroin-related overdose death rates increased across all age groups from years 2011 to 2015 with the highest rates consistently among 25-34-year-olds. The majority of the heroin and fentanyl overdose decedents had histories of substantial exposures to legally acquired prescription opioids. Law enforcement drug submission data were strongly correlated with drug overdose ED and mortality data. The 2016 crude rate of heroin-related overdose ED visits was 104/100,000, a 68% increase from 2015 (62/100,000). More fentanyl-related overdose deaths were reported between October, 2015, and September, 2016, than ED visits, in striking contrast with the observed ratio of >10 to 1 heroin-related overdose ED visits to deaths. Many fatal fentanyl overdoses were associated with heroin adulterated with fentanyl; <40% of the heroin overdose ED discharge records listed procedure codes for drug screening. CONCLUSIONS The lack of routine ED drug testing likely resulted in underreporting of non-fatal overdoses involving fentanyl and other synthetic drugs. In order to inform coordinated public health and safety responses, drug overdose surveillance must move from a reactive to a proactive mode, utilizing the infrastructure for electronic health records.

Using Enforcement and Adjudication Data to Assess the Impact of a Primary Safety Belt Law

INTRODUCTION Injuries and fatalities due to large truck and other vehicle crashes have decreased over the last decade, but motor vehicle injuries remain a leading cause of death for both the working and general populations. The present study was undertaken to determine semi truck driver and sleeper berth passenger injury risk in a moving semi truck collision using a matched-pair cohort study. METHOD Study data were obtained from the Kentucky Collision Report Analysis for Safer Highways (CRASH) electronic files for 2000-2010. A matched-pair cohort study was used to compare the odds of injury of both drivers and sleeper berth passengers within the same semi truck controlling for variables specific to the crash or the semi truck. The crude odds ratio of injury was estimated and a statistical model for a correlated outcome using generalized estimating equations was utilized. RESULTS In a moving semi truck collision, the odds for an injury were increased by 2.25 times for both semi truck drivers and sleeper berth passengers who did not use occupant safety restraints compared to semi truck drivers and sleeper berth passengers who used occupant safety restraints at the time of the collision. The driver seat or sleeper berth position in the vehicle was not a significant factor (p-value=0.31) associated with a moving semi truck collision injury. CONCLUSION Nonuse of occupant safety restraints by either drivers or sleeper berth passengers significantly increased the odds of an injury in a moving semi truck collision; semi truck seating position (drivers seat or sleeper berth) did not increase the odds for an injury in moving collisions. IMPACT ON INDUSTRY Trucking companies should include the mandatory use of occupant safety restraints by both semi truck drivers and sleeper berth passengers in their company safety policies.