USF Social Emergency Medicine Section Update Winter 2022

The Social Emergency Medicine Section at USF/TGH works to integrate structural competency into medical education and patient care through innovative assemblages of new pathways.

Our work with infectious disease and substance use disorder best exemplifies early success of the model.

Our pathways are built through collaboration with social scientists, public health experts, physicians, other care providers, and patients. We believe that direct clinical involvement of social scientists is a novel key to our success.

Faculty and Staff

Medical Directors: Jason Wilson, MD, MA, FACEP & Asa Oxner, MD (IDEA, TBSM)

SEM Section Director: Heather Henderson, MA, PhD(c)

Associate SEM Section Director/Post-Doc: Bernice McCoy, PhD

IDEA Tampa SSP Supervisor: Micah Boyer, PhD

Regulatory and IRB: Emily Holbrook, MA

Linkage to Care Coordinator: Megan Sarmento, MA

Research and Qualitative Data: Bree Casper, MA

Program Timeline May 2016 - December 31, 2021

2015

USF EM (Jason Wilson, MD) initiated non-targeted HIV screening in the ED utilizing cheek swab rapid test kits administered by in-kind staff support from DOH contracted organizations. Testing volume was low (1-2 patients/day)

2016

Jason Wilson, MD, USF Emergency Medicine, was awarded a Frontline of Communities in the United States (FOCUS) award that funded serum based non-targeted (CDC guideline based) HIV and HCV screening in the ED.

2017

Expansion of the program to TGH Brandon Healthplex

Through IT support and automation, testing volume rose to, and stabilized at approximately 22% of the ED volume over the age of 13 (over 1,000 HIV and over 1,000 HCV tests per month).

ED based HCV screening demonstrated high volume of people who inject drugs (PWID) among new cases of HCV outside of age cohort (born after 1965)

2018

ED BASED MAT (ED BRIDGE)

Launch of the Medication Assisted Therapy (MAT) or Medication for Opioid Use Disorder (MOUD) in September 2018. ED MAT has been named ED BRIDGE (Building Recovery Integration for Drug Users)

Features of ED BRIDGE include buprenorphine in ED, buprenorphine bridging Rx, peers, and direct linkage to care

Partnerships for Warm Handoff Established with DACCO (now the Cove), ACTS, and collaboration with Central Florida Behavioral Health Network (CFBHN)

2019

Services were also expanded to maternal antepartum and postpartum patients

Jason Wilson, MD was awarded a NIDA ED-INNOVATION site award, providing multiple years of research assistant, Peer and medication in ED funding for Buprenorphine while measuring outcomes in patients given injectable buprenorphine compared to those that receive sublingual buprenorphine. ClinicalTrials.Gov Protocol

Initiation of ED based take home Naloxone Nasal Spray [Narcan] program (funded through DCF/SAMHSA/SOAR), expanded to IDEA and hospital floor

ED BRIDGE program was expanded to USF Internal Medicine and the addition of the USF OBOT clinic

Addition of Peer Recovery Specialists: through SAMHSA/SOAR funding and partnership with Central Florida Behavior Healthcare Network, the first ED based certified peer recovery specialist was employed. In 2020, a second peer joined the ED team and, in 2021, we received funding for a third peer.

2020

ED BRIDGE expanded to include alcohol, benzodiazepenes and other substances beginning in 2019 and integrated further in 2020.

2021

• Expansion from 1 physician with DATA2000 (Buprenorphine X-waiver) to 12 physicians with waiver. Expansion of ED discharge with buprenorphine prescription.
• Top percentile in ACEP E-QUAL Opioid Quality Benchmarking.
• USF/TGH/IDEA awarded Hillsborough County EHE Ryan White Funding for HIV Screening and Linkage
• Asa Oxner, MD awarded Avenir NIH grant for HIV services in collaboration with University of Miami
• Jason Wilson, MD was appointed to the leadership team of the new USF Center for Justice Research and Policy. This multi-disciplinary center is housed in the College of Arts and Sciences at the University of South Florida and will be used to facilitate expertise across law enforcement, medicine, social science, and policy.
• The Launch of IDEA Tampa (Syringe Services Program)

IDEA Tampa

Infectious Disease Elimination Act (IDEA) expanded by Florida Legislature and signed into law by Governor Desantis on June 27, 2019 to allow any county to sanction one sterile syringe exchange program (aka syringe services program, SSP).

SSP has formal evaluation program operated jointly by USF Department of Anthropology and USF College of Public Health

IDEA Tampa is jointly operated by the Social Emergency Medicine Section within the Division of Emergency Medicine, Department of Internal Medicine, Morsani College of Medicine the USF Tampa Bay Street Medicine, Department of Internal Medicine.

Jason Wilson, MD and Asa Oxner serve as program Medical Directors.

The SSP is supported by grants and awards, many of which are tied to HIV and HCV testing and linkage to care

IDEA awarded FOCUS funding in December 2021 to expand phlebotomy training to conduct HCV RNA and other serum testing

IDEA Participants are provided Nasal Spray naloxone [Narcan] and postage paid postcards to anonymously report Narcan use for overdose reversal

Tampa General Hospital has an agreement with Hillsborough County Board of County Commissioners and letter of support from DOH to operate the SSP

IDEA Tampa Syringe Services Program (SSP) launched in January 2021.?The Florida DOH has more information about the Infectious Disease Elimination Act.

Over 2 million dollars of HIV, HCV, and opioid use disorder support has been provided through the FOCUS award between May 2016 and May 2021. In May 2021, USF EM/Tampa General Hospital entered grant year 6. Other financial support has come from the IDEA Miami program, the Comer Foundation, Avenir Award, and the Hillsborough County Ryan White EHE Program

2022

Jason Wilson, MD will serve as site PI for a PCORI funded project (AD-2019C1-16066, PI = Conner, USF) aimed at decreasing health disparities during transitions of care utilizing peer navigators.IDEA Tampa awarded Comer grant for supplies and associated SSP costs

Further integration of medical anthropologists into clinical pathway creation will also take place through exploration of the CMS Hospital at Home program which will require in-home social determinants of health assessments for success.

ED Based HIV/HCV Screening and Linkage

May 2016- December 31, 2021

ED BRIDGE

ED BRIDGE (Building Recovery Integration for Drug Users)

Peer guided, utilization of buprenorphine in the ED, take home naloxone, and warm hand-off with community partners

Total Unique ED Patient Enrollments: 688

Ratio of ED OD to OUD Patients Sampled: 7.17% (99th percentile, ACEP E-QUAL)

Take Home Naloxone Offered in ED: 48.38% (99th percentile,?ACEP E-QUAL)

OD Prevention or Harm Reduction Discussed Documented: 100% (99th percentile, ACEP E-QUAL)

Substance Use Evaluation in ED: 100% (99th percentile, ACEP E-QUAL)

Treatment Administered in the ED: 51.23% (99th percentile, ACEP E-QUAL)

Buprenorphine Prescribed at Discharge ED: 56.13%(99th percentile, ACEP E-QUAL)

Referral to Substance Use Disorder Treatment Offered ED: 100% (99th percentile, ACEP E-QUAL)

Emergency Medicine Physicians with X-Waiver: 13 (99th percentile, ACEP E-QUAL)

IDEA TAMPA

January 2021 – December 2021

IDEA TAMPA January 1, 2021 – December 31, 2021

Total Unique Participants: 540

Total IDEA Encounters: 1,985

Avg. New IDEA Participants/Month: 44.1

Repeat IDEA Exchanges: 1,430

Avg IDEA Encounters/Month: 156.1

Syringes In: 117,532, Syringes Out: 114,748

Naloxone Given: 1,774

Avg Naloxone Dispensed/Month: 147.8

Total Overdoses Reversed (Documented): 1,310

IDEA Exchange Outcomes

HIV Tests: 215, HIV+: 4, Seropositivity: 1.86%

HCV Tests: 230, HCV Ab+ 169

Homeless/Unstable Housing: 41.4%

Veterans: 15%

Hillsborough County Health Care Plan: 10%

Uninsured: 47.8%

No wound issues after enrollment: 90.6%

56.2% of IDEA Exchange Participants reported one or more prior overdose events.

Social Emergency Medicine Section Publications

The USF EM SEM Section is exemplified well through work on opioid use disorder and infectious disease. However, we also have made an impact working with problems around low English proficiency, firearm violence, stigma and suffering of Sickle Cell Disease, patient experiences and mental illness. Much of that work is further outlined in a new book, Clinical Anthropology 2.0, as well as the publications below.

Clinical Anthropology 2.0: Improving Medical Education and the Patient Experience. Wilson and Baer (2022) details real cases of social emergency medicine through specific case examples.?You can read more about the book, the chapters/content and how to obtain a copy at this link.

Henderson, H, Wilson, JW, McCoy, B. Applied Medical Anthropology and Structurally Informed Emergency Care in the Evolving Context of COVID-19. Human Organization. November 29, 2021. 80(4): 263-271.

Villalona, S, Casta?eda, H, Wilson, JW, Romero-Daza, N; Yanez Yuncosa, M, Jeannot, C. Discordance Between Satisfaction and Health Literacy Among Spanish-Speaking Patients with Limited English-Proficiency Seeking Emergency Department Care. Hispanic Health Care International. Online Ahead of Print. December 21, 2021. PMID: 34931564

Wilson, JW, Romero-Daza, N; Yanez Yuncosa, M, Jeannot, C. Discordance Between Satisfaction and Health Literacy Among Spanish-Speaking Patients with Limited English-Proficiency Seeking Emergency Department Care. Hispanic Health Care International. Online Ahead of Print. December 21, 2021. PMID: 34931564

Hudson, MF, Strassels, SA, Durham, DD, Sidique, S, Adler, D, Jim-Yeung, S-C, Bernstein, SL, Baugh, CW, Coyne, CJ, Grudzen, CR, Henning, DJ, Klotz, A, Madsen, TE, Pallin, DJ, Reyes, CC, Rico, JF, Ryan, RJ, Shapiro, NI, Swor, R, Venkat, A, Wilson, JW, Thomas, CR, Bischof, JJ, Lyman, GH, Caterino, JM. Examining Pain Among Non-Hispanic Black and Non-Hispanic White Patients with Cancer Visiting Emergency Departments: CONCERN (Comprehensive Oncologic Emergencies Research Network). Academic Emergency Medicine. October 4, 2021. Published ahead of print. PMID: 34606137.

Faryar, KA, Henderson, H, Wilson, JW., May, LS, Schechter-Perkins, EM, Waxman, M, Rothman, RE, Haukoos, JS, Lyons, MS. COVID-19 and Beyond: Lessons Learned from Emergency Department HIV Screening for Population-Based Screening in Healthcare Settings. Journal of the American College of Emergency Physicians Open. Journal of the American College of Emergency Physicians Open. June 22, 2021. Volume 2(3). PMID: 34189516.

Villalona, S, Wilson, JW, Boxtha, C, Cervantes, C, & Webb, W. “I Felt Invisible Most of the Time”. Communication and Satisfaction Among Patients Treated in ED Hallway Beds. Published Online American Journal of Emergency Medicine on May 4, 2020. PMID 3247563

Villalona, S, Jeannot, C, Yanez, M, Webb, W, Boxtha, C, and Wilson, JW. Minimizing Variability in Interpretation Modality Among Spanish Speaking Patients with Limited English Proficiency. Hispanic Health Care International. 2019 July 20. PMID: 31220928

Schechter-Perkins, EM, Rothman, R, Faryar, K, Waxman, M, Hansoti, B, Lyons, M Hsieh, Y-H, Klein, E, May, L, Wilson, JW, and Martin, DR on behalf of the SAEM Emergency Medicine Transmissible Infectious Diseases and Epidemics interest group. Emergency Departments Can Bolster Influenza and COVID-19 Vaccination Programs: An EMTIDE Support Statement. SAEM PULSE. January-February 2021. Last Accessed February 2, 2021

Villalona, S, Boxtha, C, Cervantes, C, Webb, W, Casteneda, H, and Wilson, JW. “If at Least the Patient Could Not Be Forgotten About”: Communication in the Emergency Department as a Predictor of Patient Satisfaction. Journal of Patient Experience. December 7, 2020(6):1015-1021. PMID 33457540

Wilson, JW, Sanmugalingham, G, Ozoya, O, Mueller-Pierce, L, Hundley, K, and Palakurty, SH. Acute HIV Infection in a Patient with Repeat HIV Antibody/Antigen Negative Resulting Presenting at an Urban Emergency Department: a Case Report. Journal of Emergency Medicine. Epublished. September 26, 2019. October 57(4): e113-e116. PMID 31500995

Wilson, JW, Baer, RD, and Villalona SK. Patient Shadowing: An Integral Research Method, Teaching Tool for Premedical Undergraduates and Approach to Student Professional Development. Academic Medicine. ePublished Ahead of Print July 16, 2019. November 2019 94(11):1722-1727. PMID 31335819

Social Emergency Medicine Section

Oral and Poster Presentations 2016-2021

Magrath, P, Guerra Reyes, L, Wilson, JW, Edberg, M. Reimagining Anthropological Engagements with the Health Sciences in the Covid 19 Era: What Can We Offer? Round Table 3-2011. Presented at the American Anthropological Association, Baltimore, Maryland. November 19, 2021.

Wilson, JW, Baer, R. Fostering “good” medicine by shifting the clinical gaze: Improving patient centered care by integrating medical anthropology into physician training and clinical spaces. Panel 7. Enhancing ways of knowing. Radical Health. Doing Medicine, Health Care, and Anthropology of the Good. Berlin, Germany (Virtual). June 27, 2021.

Wilson, JW, Henderson, H, and Pereira K. False Positive or Acute Seroconversion? Update. Examination of Patterns of HIV in the ED. American College of Emergency Physicians Scientific Assembly, Abstract 199. October 2020.

Wilson, JW, Henderson, H, and Pereira, K. False Positive or Acute Seroconversion? Examination of Patterns of Equivocal Human Immunodeficiency Virus Screening in the Emergency Department. Selected as an Oral Lightning Abstract. Presented by Jason Wilson. Society for Academic Emergency Medicine Virtual Scientific Assembly, Original Date, May 2020. YouTube upload August 1, 2020.

Gopal, J, Wallach, W, Wilson, JW. Surveying resiliency and burnout among emergency medicine resident physicians. Selected as an Oral Lightning Abstract. Presented by Jay Gopal and William Wallach. Society for Academic Emergency Medicine Virtual Scientific Assembly, Original Date, May 2020 Covid Delayed Until August 1, 2020.

McWilliams, K, Palakurty, S-H, Hazlett, A, Henderson, H. and Wilson, JW. Identifying Acute HIV Infection in the Emergency Department. Abstract 314. Accepted for Presentation at the American College of Emergency Physicians, Scientific Assembly, Research Forum. October 29, 2019. Presented by Kelly McWilliams.

Henderson, H, McGeachy, J, and Wilson, JW. An ED Based Medication Assisted Therapy Pathway for Opioid Use Disorder that Does Not Require Data 2000 Waiver. Abstract 54. Accepted for Presentation at the American College of Emergency Physicians, Scientific Assembly, Research Forum. October 27, 2019. Poster Presentation. Presented by Heather Henderson.

Travis, B, Henderson, H, Patel, H, Ozoya, O, and Wilson, JW. Empiric Versus Follow Up Treatment Rates of Chlamydia and Gonorrhea at an Urban Emergency Department. Abstract 212. Accepted for Presentation at the American College of Emergency Physicians, Scientific Assembly, Research Forum. October 28, 2019. Poster Presentation. Presented by Brandi Travis.

Wilson, JW. Co-locating Epidemics: HCV and IV Drug Use. Accepted for Oral Presentation at the American Academy of Emergency Medicine Mediterranean Emergency Medicine Conference. Dubrovnik, Croatia. September 2019. Oral Presentation.

Henderson, H, Terwilliger, Z, Ozoya, O, Travis, B, and Wilson, JW. Hepatitis C Linkage to Care Outcomes in an Urban, Academic Emergency Department. Poster Presentation (Heather Henderson). Society for Academic Emergency Medicine Annual Meeting. Las Vegas, Nevada. May 16, 2019. Poster Presentation. Presented by Heather Henderson.

Wilson, JW. Mixed Methodologies, Medical Anthropology and Clinical Applicability. Panel Chair and Discussant, Society for Applied Anthropology (SfAA), Portland, Oregon, March 23, 2019. Oral Presentation.

Wilson, JW. Presenter. Anthropology, Gun Violence, Gun Control. Round Table Discussion. American Anthropological Association. Annual Meeting. November 17, 2018. San Jose, California. Oral Presentation

Wilson, JW. Anthropology and Special Patient Populations in the Emergency Department (TH-160). Panel Chair and Discussant, Society for Applied Anthropology (SfAA), Philadelphia Pennsylvania. April 5, 2018, Philadelphia, Pennsylvania. Oral Presentation.

Villalona, S. and Wilson, JW. Patient Experience and Patient Satisfaction: Anthropologically Examining the Impact of Hallway Placement on Perceptions of Care. Presentation as part of Anthropology and Special Patient Populations in the Emergency Department (TH-160). Society for Applied Anthropology (sfAA), Philadelphia Pennsylvania. Presented by Seiichi Villalona, April 5, 2018.

Henderson, H. and Wilson, JW. Evolving Epidemiology: Perceptions of Stigma and Access to Care in Acute Opioid Crisis. Presentation as part of Anthropology and Special Patient Populations in the Emergency Department (TH-160). Society for Applied Anthropology (sfAA), Philadelphia Pennsylvania. Presented by Heather Henderson, April 5, 2018.

Osorno-Cruz, C. and Wilson, JW. Understanding the Sickle-Cell Patient Experience nad New Approaches to Pain Management. Presentation as part of Anthropology and Special Patient Populations in the Emergency Department (TH-160). Society for Applied Anthropology (sfAA), Philadelphia Pennsylvania. Presented by Carlos Osorno-Cruz, April 5, 2018.

Kelly, K., Baer, R. and Wilson, JW. The Patient Perspective: Applying Medical Anthropology to the Patient Experience in the Emergency Department. Presentation as part of Anthropology and Special Patient Populations in the Emergency Department (TH-160). Society for Applied Anthropology (sfAA), Philadelphia Pennsylvania. Presented by Kilian Kelly, April 5, 2018.

Villalona, S, Baer, R. and Wilson, JW. Reimagining the Shadowing and Research Experiences of Undergraduate Pre-Medical Students. Presented by Seiichi Villalona at the American Association of Medical Colleges, Western Group on Educational Affairs Regional Conference, March 25, 2018.

Mueller, L, Sanmugalingham, G, Ozoya, O, and Wilson, JW. Improvement of HIV screening rates in an Urban Emergency Department Using a Best Practice Alert: A Quality Improvement Study. Moderated ePoster Presented by Wilson, J., Society of Academic Emergency Medicine, Orlando, Florida. May 16-19, 2017.

Villalona, S. SaintHillaire, R. and Wilson, JW. Assessments of ED Hallway Placement and Perceived Deficiencies in Pain Management on Press Ganey Scores. Poster Presentation, Society for Academic Emergency Medicine, Orlando Florida. May 16-19, 2017.

Baer, R. Wilson, JW, and Villalona, S. The ER: Patient and Physician Perspectives. Presented at the American Anthropological Association, November 2016. Presented by Roberta Baer.

Mueller L, Wilson J, Ozoya O, Segarra D, Sanmugalingham G. Preliminary analysis of staff attitudes of an expanded HIV testing program in an urban Emergency Department (ED). Poster presentation. Symposium by the Sea; Florida College of Emergency Physicians, Naples, FL. August 2016. Poster was runner-up in research competition. Mentoring Physician for Resident Scholarly Activity, study concept and design, corresponding author. Presenter: Larissa Mueller, MD.

Mueller L, Wilson JW, Ozoya O, Segarra D, Sanmugalingham G. Interim Analysis: Benefits of a Standardized Exercise Program in Treatment of ED Patients Experiencing Acute or Acute- on-Chronic Musculoskeletal Back Pain. Poster presentation. Symposium by the Sea; Florida College of Emergency Physicians, Naples, FL. August 2016. Poster won first place in research competition. Mentoring Physician for Resident Scholarly Activity, study concept/design, corresponding author. Presenter: Oluwatobi Ozoya, MBBS.

Media Coverage

Tampa Needle Exchanges Saves Lives by Preventing Overdoses, Infections.. Tampa Bay Times. Margo Snipe. December 28, 2021.

USF Health Tampa Bay Street Medicine Helps Launch Florida’s Second Needle Exchange Program. Torie Doll. November 10, 2020.

First Ever Needle Exchange Program In Hillsborough County Approved by Commissioners. Angela Cordoba Perez. February 10, 2020.

Future Directions

Our goal is to create, implement and operate a regional, coordinated, harm reduction system where patients are linked to services at multiple pathway points along the recovery continuum.

Please Donate!

You can make a tax-deductible gift to this program through the USF Foundation. Just follow this link and type in IDEA Exchange in the search box. Your gift can be a one time or reoccurring donation. Thank you!

Donate Supplies

Do you prefer to donate supplies instead of cash? Great. We have an Amazon Wish List at this link!

Volunteer!

Are you interested in volunteering with us? Please complete the information form found at this link and we will be in touch!

Social Emergency Medicine Section, Division of Emergency Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa General Hospital

The FOCUS Program is a public health initiative that enables partners to develop and share best practices in routine blood-borne virus (HIV, HCV, HBV) screening,diagnosis, and linkage to care in accordance with screening guidelines promulgated by the U.S. Centers for Disease Control and Prevention (CDC), the U.S. Preventive Services Task Force (USPSTF), and state and local public health departments. FOCUS funding supports HIV, HCV, and HBV screening and linkage to the first medical appointment after diagnosis. FOCUS partners do not use FOCUS awards for activities beyond linkage to the first medical appointment.