ABSTRACT
OBJECTIVE: Examine the nature of domestic and family violence (DFV) presentations to an ED in the Northern Territory and identify potential gaps in service delivery. METHODS: Prospective descriptive study of DFV presentations in November 2021. RESULTS: A total of 70 presentations were identified, representing 1.2% of all presentations aged 16 years and older. Disproportionately impacted were First Nations people (90%), women (77.1%) and those aged less than 40 years (67.1%). Most (81.4%) arrived outside of business hours and only 37.1% were assessed by the social worker. Case complexity was increased by high rates of homelessness (30%), concurrent alcohol consumption (44.3%) and pregnancy (11.1% of females). More than a third (37.1%) had attended on one to four occasions in the previous 6 months with a DFV-related injury. Compared to non-DFV attendances, the median ED length of stay was approximately twice as long (456 vs 210 min), admissions rates to the ED short stay unit five times higher (25.7% vs 5.7%; P < 0.01, odds ratio [OR] = 5.7 and 95% confidence interval [CI] = 3.3-9.8) and rates of self-discharge prior to completion of care 9 times higher (12.9% vs 1.5%; P < 0.01, OR = 9.5 and 95% CI = 4.6-19.7). CONCLUSION: The data highlights the need for a 24 h trauma-informed, culturally safe and integrated service to support people experiencing DFV. This could be achieved by a specialist unit designed and staffed by First Nations health practitioners.
ABSTRACT
BACKGROUND: Injectable naloxone is already provided as take-home naloxone (THN), and new concentrated intranasal naloxone is now being introduced in Europe. Despite evidence of the effectiveness and cost-effectiveness of THN, little is known about the attitudes of key target populations: people who use opioids (PWUO), family/friends, and staff. We examined the acceptability of different naloxone devices (ampoule, prefilled syringe, and concentrated nasal spray) across 5 European countries. OBJECTIVES: The aim of this study was to compare THN target groups (PWUO vs. family/friends vs. staff) in their past rates of witnessed overdose and THN administration (as indicators of future use), current THN device preference, and THN carriage on the day of survey. METHOD: Cross-sectional survey of respondents (age ≥18) in addiction treatment, harm reduction, and recovery services in Denmark, England, Estonia, Norway, and Scotland. A purpose-developed questionnaire (59 items) was administered in the local language electronically or in a pen-and-paper format. RESULTS: Among n = 725 participants, 458 were PWUO (63.2%), 214 staff (29.5%), and 53 (7.3%) family members. The groups differed significantly in their likelihood-of-future THN use (p < 0.001): PWUO had the highest rate of previously witnessing overdoses (352; 77.7%), and staff members reported the highest past naloxone use (62; 30.1%). Across all groups, most respondents (503; 72.4%) perceived the nasal spray device to be the easiest to use. Most reported willingness to use the spray in an overdose emergency (508; 73.5%), followed by the prefilled syringe (457; 66.2%) and ampoules (64; 38.2%). Average THN carriage was 18.6%, ranging from 17.4% (PWUO) to 29.6% (family members). CONCLUSION: Respondents considered the concentrated naloxone nasal spray the easiest device to use. Still, most expressed willingness to use the nasal spray as well as the prefilled syringe in an overdose emergency. Carriage rates were generally low, with fewer than 1 in 5 respondents carrying their THN kit on the day of the survey.
