Project description:IntroductionLaw enforcement officers (LEO) interact with patients and clinicians in the emergency department (ED) for many reasons. There is no current consensus on what should comprise, or how to best enact, guidelines that ideally balance LEO activities in the service of public safety with patient health, autonomy, and privacy. The purpose of this study was to explore how a national sample of emergency physicians (EP) perceives activities of LEOs during the delivery of emergency medical care.MethodsMembers of the Emergency Medicine Practice Research Network (EMPRN) were recruited via an email-delivered, anonymous survey that elicited experiences, perceptions, and knowledge of policies that guide interactions with LEOs in the ED. The survey included multiple-choice items, which we analyzed descriptively, and open-ended questions, which we analyzed using qualitative content analysis.ResultsOf 765 EPs in the EMPRN, 141 (18.4%) completed the survey. Respondents represented diverse locations and years in practice. A total of 113 (82%) respondents were White, and 114 (81%) were male. Over a third reported LEO presence in the ED on a daily basis. A majority (62%) perceived LEO presence as helpful for clinicians and clinical practice. When asked about the factors deemed highly important in allowing LEOs to access patients during care, 75% reported patients' potential as a threat to public safety. A small minority of respondents (12%) considered the patients' consent or preference to interact with LEOs. While 86% of EPs felt that information-gathering by LEO was appropriate in the ED setting, only 13% were aware of policy to guide these decisions. Perceived barriers to implementation of policy in this area included: issues of enforcement; leadership; education; operational challenges; and potential negative consequences.ConclusionFuture research is warranted to explore how policies and practices that guide intersections between emergency medical care and law enforcement impact patients, clinicians, and the communities that health systems serve.

Project description:ObjectiveTo determine the proportion of privately insured adults using an out-of-network physician, the prevalence of involuntary out-of-network use, and whether patients experienced problems with cost transparency using out-of-network physicians.Data sourcesNationally representative internet panel survey conducted in February 2011.Study designScreener questions identified a sample of 7,812 individuals in private health insurance plans with provider networks who utilized health services within the prior 12 months. Participants reported details of their inpatient and outpatient contacts with out-of-network physicians. An inpatient out-of-network contact was defined as involuntary if: (1) it was due to a medical emergency; (2) the physician's out-of-network status was unknown at the time of the contact; or (3) an attempt was made to find an in-network physician in the hospital but none was available. Outpatient contacts were only defined as involuntary if the physician's out-of-network status was unknown at the time of the contact.Principal findingsEight percent of respondents used an out-of-network physician. Approximately 40 percent of individuals using out-of-network physicians experienced involuntary out-of-network care. Among out-of-network physician contacts, 58 percent of inpatient contacts and 15 percent of outpatient contacts were involuntary. The majority of inpatient involuntary contacts were due to medical emergencies (68 percent). In an additional 31 percent, the physician's out-of-network status was unknown at the time of the contact. Half (52 percent) of individuals using out-of-network services experienced at least one contact with an out-of-network physician where cost was not transparent at the time of care.ConclusionsThe frequency of involuntary out-of-network care is not inconsequential. Policy interventions can increase receipt of cost information prior to using out-of-network physician services, but they may be less helpful when patients have constrained physician choice due to emergent problems or limited in-hospital physician networks.

Project description:ImportanceUnderstanding knowledge of, attitudes toward, and willingness to use extreme risk protection order (ERPO) laws among law enforcement officers (LEOs) can inform efforts to improve implementation of this underused firearm violence prevention strategy.ObjectiveTo characterize LEOs' knowledge of, attitudes toward, and willingness to use ERPOs across a range of scenarios.Design, setting, and participantsA cross-sectional online survey, fielded from April 5 to August 30, 2021, was conducted in all 19 states and the District of Columbia with an ERPO law in 2021. A nonprobability sample of active-duty LEOs was used.ExposureBeing a LEO in a state with an ERPO law.Main outcomes and measuresSurvey participants answered questions about their familiarity with and opinions on ERPO laws, as well as whether they would agree with using an ERPO in a variety of specific case scenarios. The analysis included an exploration of whether within-scenario differences, such as ERPO respondent race or gender, affected agreement by randomly assigning survey participants to 1 of 2 versions of each scenario.ResultsA total of 600 eligible individuals started the survey, and 283 survey participants were included in the analysis. The analytic sample consisted mostly of cisgender men (85.2%) and non-Hispanic White (71.4%) LEOs. Participants represented 14 states and the District of Columbia, with 53.7% living in California. Most participants (81.3%) were very or somewhat familiar with ERPO laws and 56.2% had received ERPO training. Opinions about ERPO laws were generally favorable but varied by self-identified political ideology. Across all scenarios, most participants supported using an ERPO; however, support was highest in cases involving intimate partner violence (71.4%-78.6%) and lowest in cases involving suicidality (54.2%-73.3%). Across all scenarios, LEOs with ERPO training or experience were substantially more likely to agree with using ERPOs than those without. None of the randomly assigned within-scenario differences were associated with differences in ERPO support.Conclusions and relevanceIn this survey study of LEOs in states with ERPO laws, many officers had not received training on their use. Additionally, while conservative political ideology was associated with less favorable views of ERPOs, training and experience with ERPOs was associated with greater support for their use across a range of scenarios. These findings suggest that LEO training on ERPOs may promote their uptake and improve implementation.

Dataset Information

Use of Involuntary Emergency Treatment by Physicians and Law Enforcement for Persons With High-Risk Drug Use or Alcohol Dependence.

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