Policing the Police: A Retrospective Analysis of Racial and Ethnic Disparities in Police Encounters at a Public Research Medical University

Posted on May 18, 2022May 18, 2022 by coprhcon

RESULTS

Among the 5118 police encounters, 13.2% (680) resulted in arrests. White individuals made up 73.2% (3,499) of total encounters and 64.4% (434) of arrests (p<0.001). Black and Latinx individuals made up 22.2% and 19.1% of encounters respectively and made up 33.1% and 27.7% of all arrests (p<0.001). Furthermore, Black (RR 1.52, 95% CI: 1.26-1.83, p<0.001) and Latinx (RR 1.41, 95% CI: 1.16-1.71, p<0.001) individuals had a greater likelihood of their encounters leading to arrest when compared to White individuals after adjusting for age, sex, crime classification, and reason for being on campus. Compared to White individuals, Black individuals were 7.79 (95% CI 1.35-44.9) times more likely to be arrested for a suspicious incident and American Indian/Alaskan Native individuals were 5.5 (95% CI: 3.19-9.33) times more likely to be arrested for an assault. American Indian/Alaskan Native (RR 7.14, 95% CI: 5.76-9.21), Black (RR 1.52, 95% CI: 1.04-2.22), and Latinx (RR 1.35, 95% CI: 1.13-1.60) individuals were more likely to be arrested if they were unaffiliated with the campus. [/su_box]

Addressing Substance Use Disorders to End the HIV Epidemic: The Power of Community Stakeholder Perspectives

Posted on May 18, 2022May 18, 2022 by coprhcon

METHODS

We used an innovative Stakeholder-Engaged Real-Time Delphi (SE-RTD) method to identify (1) which SUDs have the greatest population-level negative impact, (2) which SUD interventions have the best fit for integration into HSOs, and (3) which strategies AETCs can use to support integration of SUD interventions into real world HSO settings. Each SE-RTD engaged stakeholders over a two-week period, which involved learning about (1) SUDs, (2) SUD interventions, or (3) strategies for exploring, preparing, and implementing SUD interventions, rating them across various dimensions, explaining initial responses, reviewing others’ responses and comments, and changing responses if inclined. This interactive method facilitates consensus among participating stakeholders by enabling asynchronous perspective sharing.

RESULTS

Our first SE-RTD engaged 643 PWH, HSO staff, and HIV planning council/body members and identified alcohol, methamphetamine, and opioid use disorders as having the greatest population-level negative impact. Representatives of 202 HSOs participated in our second SE-RTD and rated three evidence-based psychosocial interventions for SUD (i.e., motivational interviewing, cognitive behavioral therapy, and contingency management) as having the best fit for integration into HSOs. The third SE-RTD engaged 64 AETC representatives (from 8 regional offices and 56 local partners) who rated various strategies as important for supporting integration of psychosocial interventions for SUD into HSOs but with varying levels of feasibility.

CONCLUSIONS

The findings from our project reflect insights from key stakeholders nationally and can be used to inform HIV planning councils/bodies tasked with setting priorities, assessing capacity, and allocating resources to end the HIV epidemic. Further, we are using the information gleaned from stakeholders through these SE-RTDs to inform which SUD interventions and strategies will be the focus of a novel hybrid trial seeking to improve integration of SUD services into HSOs across the United States.

Rapid Qualitative Methods to Inform Implementation of a Community Paramedicine Multi-site Pragmatic Randomized Clinical Trial

Posted on May 18, 2022May 18, 2022 by coprhcon

BACKGROUND

Practice-embedded pragmatic trials aim to generate timely evidence for translation. While balancing rigor and speed, researchers must also ensure that interventions and trial procedures are feasible, minimize practice burden, and maintain real-world conditions as much as possible. The reported qualitative research was conducted in the pre-implementation period of a trial assessing effectiveness and implementation of a community paramedic (CP) program to shorten and prevent hospitalization in adults being treated in, or referred to, the hospital or emergency department. The aim was to identify facilitators and barriers to implementation and to refine workflows, ensuring feasible program and study conduct.

METHODS

The study team identified individuals in roles likely to be involved in or impacted by the trial and invited them to complete an interview. A snowball sampling approach was used to gather additional contacts. Interviews were audio recorded and reviewed by two team members. Notes were summarized in Rapid Assessment Procedure sheets organized by constructs related to implementation determinants. The study team also presented trial information to key stakeholder groups to increase awareness and solicit questions and concerns, which were summarized in field notes. The study team met biweekly to debrief key findings and identify necessary actions, including trial adaptations to increase feasibility, acceptability, and adoption.

RESULTS

Interviews were conducted with 26 participants between December 2021 and March 2022. The mean duration was 30 minutes (range 19, 59). The study team also presented the study to 17 institutional committees and clinical departments. Barriers to implementation included low awareness of the program and CP scope of practice, ambiguous program boundaries, and logistics around program referral and use. Major concerns included CP shortages and lack of clear financial reimbursement models, need for bi-directional communication, potential for program misuse, general safety concerns with in-home care, and trial randomization procedures. Recommended changes to workflow were primarily related to trial enrollment and referral, resource management, and electronic health record utilization. Participant questions informed further study outreach, including education related to key determinants like attitudes toward CP scope of practice and perceived clinical setting constraints.