An Opportunity For Intervention: Screening For Substance Use, Suicide, And Safety In South African Emergency Departments

Background: Emergency department (ED)-based screening for substance use, suicide, and safety is commonly conducted in the United States. We sought to adopt this ED-based strategy in South Africa to determine the potential unmet needs of this population. Materials and Methods: This prospective, observational study was conducted at two sites in the Eastern Cape from June to September 2017. Adult patients presenting to the ED with noncritical conditions were approached to collect demographic data, respond to screening questions, and receive point-of-care human immunodeficiency virus testing. Screening questions assessed primary care access, substance use, suicidal thoughts, and home safety. The data analysis was performed using STATA v. 15 (StataCorp LLC, College Station, TX, USA). Descriptive statistics and cross-tabulations were performed to assess the proportion of patients with access to primary care, substance use, suicidal thoughts, and home safety. Relative risks were calculated using a generalized linear model for the appropriate exposures and outcomes. Results: Among the 2,074 patients approached, 1,880 consented to data collection. Half of the participants were male, and the median age was 34 years (interquartile range: 25-54 years). Screening questions revealed that 384 (20%) used alcohol in excess, 372 (20%) used tobacco, 174 (9%) lacked access to primary care, 69 (4%) had suicidal thoughts, and 55 (3%) felt unsafe at home. Most of those reporting substance use were male and between 25 and 34 years. Conclusions: One in five patients reported substance use, of which one in five did not have routine interaction with the health-care system. Routine ED-based screening could reach this missed population for timely intervention. The following core competencies are addressed in this article: Patient care, Practice-based learning and improvement, and Systems-based practice.