Elaine Hsiang

All Publications

• The Utility of Dot Phrases and SmartPhrases in Improving Physician Documentation of Interpreter Use. The western journal of emergency medicine Jaradeh, K., Hsiang, E., Singh, M. K., Peabody, C. R., Straube, S. 2024; 25 (3): 345-349

  Abstract

  Background: Patients with limited English proficiency (LEP) experience significant healthcare disparities. Clinicians are responsible for using and documenting their use of certified interpreters for patient encounters when appropriate. However, the data on interpreter use documentation in the emergency department (ED) is limited and variable. We sought to assess the effects of dot phrase and SmartPhrase implementation in an adult ED on the rates of documentation of interpreter use.Methods: We conducted an anonymous survey asking emergency clinicians to self-report documentation of interpreter use. We also retrospectively reviewed documentation of interpreter- services use in ED charts at three time points: 1)pre-intervention baseline; 2)post-implementation of a clinician-driven dot phrase shortcut; and 3)post-implementation of a SmartPhrase.Results: Most emergency clinicians reported using an interpreter "almost always" or "often." Our manual audit revealed that at baseline, interpreter use was documented in 35% of the initial clinician note, 4% of reassessments, and 0% of procedure notes; 52% of discharge instructions were written in the patients' preferred languages. After implementation of the dot phrase and SmartPhrase, respectively, rates of interpreter-use documentation improved to 43% and 97% of initial clinician notes, 9% and 6% of reassessments, and 5% and 35% of procedure notes, with 62% and 64% of discharge instructions written in the patients' preferred languages.Conclusion: There was a discrepancy between reported rates of interpreter use and interpreter-use documentation rates. The latter increased with the implementation of a clinician-driven dot phrase and then a SmartPhrase built into the notes. Ensuring accurate documentation of interpreter use is an impactful step in language equity for LEP patients.

  View details for DOI 10.5811/westjem.18352

  View details for PubMedID 38801040

• Association of Lesbian, Gay, Bisexual, and Transgender (LGBT) Cultural Competency Training With Provider Practice Characteristics and Perceptions of Patient Care JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT Hsiang, E., Ney, J. P., Weathers, A. L., Rosendale, N. 2024; 11: 23821205241287441

  Abstract

  While issues related to lesbian, gay, bisexual, and transgender (LGBT) health are increasingly incorporated into medical training, there remains limited guidance and opportunities for continuing medical education in LGBT health. It is unclear how participation in LGBT-specific training is distributed across physician specialties and practice regions. Additionally, national data assessing cultural competency training for physicians are scarce and do not delineate LGBT-specific training or training completed prior to, during, or after graduate medical education.Using data from the 2016 National Culturally and Linguistically Appropriate Services Physician Survey, this study evaluated patterns of post-residency cultural competency training, as well as associations between LGBT-specific training and provider perceptions of patient care outcomes.Provider specialty, practice region, and receiving cultural competency training as a trainee were associated with post-residency LGBT-specific training. Surgical providers (odds ratio [OR]: 0.42; confidence interval [CI] 0.25-0.73; p = .002) and those practicing in the South (OR: 0.49; CI: 0.26-0.92; p = .025) had lower odds of completing LGBT-specific cultural competency training while in independent practice. Post-residency LGBT-specific training was associated with provider agreement that cultural competency training improves the quality of care (OR: 2.76; CI: 1.44-5.28; p = .002), patient satisfaction (OR: 2.55; CI: 1.32-4.93; p = .005), and patient comprehension (OR: 2.03; CI: 1.05-3.90; p = .034).Our findings provide disaggregated analyses that nuance the assessment of cultural competency interventions and support a broader effort to increase attention to LGBT health in continuing medical education.

  View details for DOI 10.1177/23821205241287441

  View details for Web of Science ID 001324846000001

  View details for PubMedID 39371643

  View details for PubMedCentralID PMC11451181

• Aspiration ACADEMIC EMERGENCY MEDICINE Hsiang, E. 2022; 29 (12): 1516

  View details for DOI 10.1111/acem.14552

  View details for Web of Science ID 000898138100016

  View details for PubMedID 35730911

• Prevalence and correlates of substance use and associations with HIV-related outcomes among trans women in the San Francisco Bay Area BMC INFECTIOUS DISEASES Hsiang, E., Gyamerah, A., Baguso, G., Jain, J., McFarland, W., Wilson, E. C., Santos, G. 2022; 22 (1): 886

  Abstract

  Trans women face tremendous social inequities as well as disproportionate rates of HIV and substance use, yet disaggregated substance use data specific to trans women remain limited.We conducted a secondary analysis of baseline data from the Trans*National Study (2016-2017) surveying trans women in the San Francisco Bay Area (n = 629). Multivariable logistic regression was used to analyze socio-demographic and environmental correlates of substance use, and bivariate associations between substance use and HIV-associated outcomes are presented alongside prevalence data.Over half (52.9%) reported using substances in the prior year, most frequently marijuana, methamphetamine, and crack/cocaine. Those with unmet gender-affirming health care needs, lack of insurance, or a history of experiencing racial violence, transphobic violence, adult housing instability, or extreme poverty had higher odds of substance use. Sex work and condomless anal sex were also independently associated with substance use.Among this sample of trans women, substance use and substance use concurrent with sex were highly prevalent, and associated with a number of socioeconomic and health care needs. These findings corroborate the need for holistic and intersectional efforts to reduce substance use and HIV risk.

  View details for DOI 10.1186/s12879-022-07868-4

  View details for Web of Science ID 000888807900002

  View details for PubMedID 36435761

  View details for PubMedCentralID PMC9701418

• Emergency care of LGBTQIA plus patients requires more than understanding the acronym AEM EDUCATION AND TRAINING Hsiang, E., Ritchie, A. M., Lall, M. D., Driver, L., Moll, J., Sonn, B., Totten, V. Y., Williams, D. B., McGregor, A. J., Egan, D. J. 2022; 6: S52-S56

  Abstract

  Emergency physicians (EPs) frequently deliver care to members of the LGBTQIA+ community in the emergency department. This community suffers from many health disparities important to understand as part of comprehensive care, and these disparities are infrequently discussed in emergency medicine education. Previous data also suggest a need for broader education to increase the comfort of EPs caring for LGBTQIA+ patients. A group of content experts identified key disparities, opportunities for expanded education, and strategies for more inclusive care of LGBTQIA+ patients.

  View details for DOI 10.1002/aet2.10750

  View details for Web of Science ID 000814785200001

  View details for PubMedID 35783082

  View details for PubMedCentralID PMC9222885

• Block by block: Building on our knowledge to better care for LGBTQIA plus patients AEM EDUCATION AND TRAINING Driver, L., Egan, D. J., Hsiang, E., Lall, M. D., Moll, J., Ritchie, A. M., Sonn, B. J., Totten, V. Y., Williams, D. B., McGregor, A. J. 2022; 6: S57-S63

  Abstract

  Emergency physicians need to recognize the diversity of identities held by sexual and gender minorities, as well as the health implications and inequities experienced by these communities. Identities such as lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual, aromantic, and many others fall under the LGBTQIA+ acronym. This wide spectrum is seldom discussed in emergency medicine but nonetheless impacts both patient care and patient experience in acute and critical care settings.This commentary aims to provide a brief but nonexhaustive review of LGBTQIA+ identities and supply a critical framework for applying this understanding to patient encounters in the emergency department, as well as describe the challenges and educational aims at the level of medical school, residency, and postresidency.The commonly used and widely accepted definitions of LGBTQIA+ terms are described, as well as implications for patient care and emergency physician education. The authors of this writing group represent the Society for Academic Emergency Medicine, LGBTQ Task Force of the Academy of Diversity Inclusion in Medicine.LGB terms are addressed, with LGBTQIA+ adding "intersex," "asexual," and "+," to include other gender identities and sexual orientations which are not already included. This paper also addresses the terms "transition," "nonbinary," "polyamorous." "two-spirit," "queer," and others. These acronyms and terms continually expand and evolve in the pursuit of inclusivity. Additionally, with some health issues potentially related to medications, hormones, surgery, or to internal or external genitalia, important EM physician tools include gathering an "organ inventory," asking about sexual history, and conducting a physical exam.Most persons have congruent biological sex, gender identity, and attraction to the "opposite" gender. However, humans can have every imaginable variation and configuration of chromosomes, genitalia, gender identities, sexual attractions, and sexual behaviors. Terms and definitions are constantly changing and adapting; they may also vary by local culture. Obtaining relevant medical history, conducting an "organ inventory," asking about sexual history in a nonjudgmental way, and conducting a physical exam when warranted can all be important in delivering best possible medical care. Although there has been increased focus on education at the medical school, residency, and faculty level on LGBTQIA+ patient care in the ED, much work remains to be done.Emergency physicians should feel confident in providing a model of care that affirms the sexual and gender identities of all the patient populations we serve. Optimal patient-centric care requires a deeper understanding of the patient's biology, gender identity, and sexual behavior encapsulated into the ever-growing acronym LGBTQIA+.

  View details for DOI 10.1002/aet2.10755

  View details for Web of Science ID 000814783100001

  View details for PubMedID 35783077

  View details for PubMedCentralID PMC9222888

• SONO case series: right upper quadrant point-of-care ultrasound in assessment of the gallbladder EMERGENCY MEDICINE JOURNAL Hsiang, E., Graglia, S. 2022; 39 (6): 479-+

  View details for DOI 10.1136/emermed-2021-211923

  View details for Web of Science ID 000748644200001

  View details for PubMedID 35086912

• Oxytocin-enhanced group therapy for methamphetamine use disorder: Randomized controlled trial JOURNAL OF SUBSTANCE ABUSE TREATMENT Stauffer, C. S., Moschetto, J. M., McKernan, S., Meinzer, N., Chiang, C., Rapier, R., Hsiang, E., Norona, J., Borsari, B., Woolley, J. D. 2020; 116: 108059

  Abstract

  Methamphetamine (METH) use is a public health crisis that disproportionately affects men who have sex with men (MSM). There are currently no FDA-approved pharmacological interventions to treat methamphetamine use disorder (MUD). MUD is associated with social impairments and extremely high treatment attrition rates. Administration of oxytocin, a neuropeptide involved in social attachment, may be a novel approach to addressing these issues. Moreover, oxytocin administration has shown promise for reducing METH-related addictive behavior in animal models, but has not yet been investigated in clinical trials for MUD. Last, oxytocin is known to modulate stress responsivity via regulation of the autonomic nervous system, which is dysregulated in METH users. We hypothesize that oxytocin, in combination with group psychotherapy, will increase treatment engagement, reduce addiction behavior, and mitigate stress hyperreactivity.This is a randomized, double blind trial of oxytocin 40-IU (n = 24) or placebo (n = 24) administered intranasally prior to each of six weekly motivational interviewing group therapy (MIGT) sessions for MUD in MSM.(a) session attendance.(b) group cohesion, (c) anxiety, (d) METH craving, (e) METH use, and (f) in-session cardiac physiology.Participants receiving oxytocin had significantly higher group therapy attendance than those receiving placebo, OR 3.26, 95% CI [1.27-8.41], p = .014. There was a small effect of oxytocin on group cohension, but not anxiety or craving. METH use did not change over the six-week MIGT course in either treatment arm. Participants receiving oxytocin had lower average heart rates during MIGT sessions and higher heart rate variability. There were positive main effects of MIGT over Time regardless of study drug.This evidence, and the lack of any serious adverse events, suggests that oxytocin may safely increase treatment attendance. One possible mechanism by which it may do so is its modulation of the autonomic nervous system. Further investigation is warranted.

  View details for DOI 10.1016/j.jsat.2020.108059

  View details for Web of Science ID 000556762700008

  View details for PubMedID 32741502

  View details for PubMedCentralID PMC7491413

• Bridging the Digital Divide Among Racial and Ethnic Minority Men Who Have Sex With Men to Reduce Substance Use and HIV Risk: Mixed Methods Feasibility Study JMIR MHEALTH AND UHEALTH Hsiang, E., Offer, C., Prescott, M., Rodriguez, A., Behar, E., Matheson, T., Santa Maria, D., Santos, G. 2020; 8 (4): e15282

  Abstract

  Ecological momentary assessment (EMA) is a promising data collection tool for mobile health interventions targeting episodic health behaviors. For substance-using men who have sex with men (SUMSM), EMA is becoming more widely utilized in efforts to characterize substance use and sexual risk factors for HIV transmission. However, recent literature demonstrates emerging concerns over compliance and lower EMA engagement and data concordance among racial and ethnic minority SUMSM.This study aimed to provide a qualitative evaluation of the barriers and facilitators of EMA as a data collection tool among racial and ethnic minority SUMSM.Between October and November 2017, 45 racial and ethnic minority SUMSM were recruited from a list of prior research participants at the San Francisco Department of Public Health to participate in daily EMA surveys on their substance use and sexual health behaviors for 1 week, followed by in-person focus groups (FGs). A total of 4 FGs explored the participants' experiences with the surveys, issues regarding privacy and confidentiality, and suggestions for improvement. Qualitative analysis was performed using content analysis. Descriptive statistics and Fisher exact tests were used to assess the associations between demographics or substance use behaviors and EMA completion.Overall, 93.9% (295/314) of all delivered surveys were initiated, and of those, 98.0% (289/295) were completed. Neither participant demographics, including race (P=.65) or age (P=.43), nor substance use behaviors, including the frequency of alcohol (P=.40) or methamphetamine (P=.91) use or any cocaine (P=.28), crack (P=.99), or polysubstance use (P=.24), were found to be associated with survey completion. Overall, participants were receptive to the text message-based EMA surveys. Facilitators included survey timing, user-friendly survey design, survey-stimulated self-reflection, coding of sensitive phrases, and other privacy benefits of a mobile survey. Barriers included an inability to correct texting errors and participants' perception of judgment or stigmatization related to questions about condomless sex. To improve EMA compliance and uptake, participants suggested adding response confirmations, clarifying survey language, and continuing to diversify the study audience.EMA appears to be feasible and acceptable among this sample of racial and ethnic minority SUMSM. Close attention to EMA study design and the development of nonjudgmental, contextualized questions regarding stigmatized health behaviors may be critical to further improve EMA compliance.

  View details for DOI 10.2196/15282

  View details for Web of Science ID 000529334400001

  View details for PubMedID 32347807

  View details for PubMedCentralID PMC7221651

• Oxytocin-enhanced motivational interviewing group therapy for methamphetamine use disorder in men who have sex with men: study protocol for a randomized controlled trial TRIALS Stauffer, C. S., Moschetto, J. M., McKernan, S. M., Hsiang, E., Borsari, B., Woolley, J. D. 2019; 20: 145

  Abstract

  The prevalence of methamphetamine use disorder (MUD) in the United States has risen dramatically in the past four decades and is concentrated in populations such as men who have sex with men (MSM). Despite the public health consequences of MUD, there are no FDA-approved psychopharmacological treatments. Psychosocial treatment alone has been shown to reduce methamphetamine use, but high attrition rates limit treatment efficacy. Promising findings from animal models of MUD using exogenous oxytocin, a social neuropeptide, have set the stage for translational work. Along with unique anti-addiction effects, oxytocin holds a primary role in enhancing social salience and modulating stress. In humans, oxytocin administration, combined with evidence-based psychosocial interventions, may act synergistically to improve addiction treatment outcomes and improve retention rates in current MUD treatment.We are conducting a randomized, double-blind, placebo-controlled trial of oxytocin-enhanced motivational interviewing group therapy (MIGT). Oxytocin or placebo 40 IU is administered intranasally in conjunction with six, weekly MIGT sessions. We will recruit 50 MSM, initiating treatment for MUD from specialized community health programs in San Francisco, CA, USA. Individuals will be randomized (1:1) to receive six, weekly sessions of MIGT with or without oxytocin. Our primary outcome is session attendance. Other outcomes of interest include: measures of group cohesion, anxiety, psychophysiology, and stimulant craving and use.This will be the first study of oxytocin's effects in humans with MUD. Findings from this novel protocol will attempt to bridge existing animal data with the need for innovative clinical treatments for MUD, inform the growing field of pharmacologically-enhanced psychotherapy, and help to elucidate mechanisms behind oxytocin's potential anti-addiction effects.ClinicalTrials.gov, ID: NCT02881177 . Registered on 26 August 2016.

  View details for DOI 10.1186/s13063-019-3225-7

  View details for Web of Science ID 000459474200001

  View details for PubMedID 30791944

  View details for PubMedCentralID PMC6385415

• Acceptability of pharmacotherapy for hazardous alcohol use among men who have sex with men: Findings from a qualitative study. Addictive behaviors reports Hsiang, E., Jennings, D., Matheson, T., Hern, J., Euren, J., Santos, G. 2018; 8: 122-127

  Abstract

  INTRODUCTION: Men who have sex with men (MSM) experience high rates of binge drinking, alcohol use disorder (AUD), and alcohol-related health issues. Pharmacotherapy for AUD can reduce hazardous drinking, yet remains underutilized among MSM. This qualitative study examined knowledge and perceptions regarding AUD medications among MSM, with an emphasis on naltrexone.METHODS: Three focus group discussions (FGDs) with MSM who consumed alcohol in the past year were conducted in February 2015 (N = 39) in the San Francisco Bay Area. The FGD guide generated discussions about hazardous drinking, the social contexts of drinking, and alcohol reduction and cessation options, including pharmacotherapy. Interviews were analyzed via directed content analysis to codify themes.RESULTS: For participants, drinking at LGBTQ bars was an important social activity. Many expressed interest in reducing alcohol use, but few had heard of pharmacotherapy for AUD. Potential uptake was limited by perceptions of disulfiram as the prototype medication, side effects associated with disulfiram, and concerns that medications do not address alcohol-related stigma or social drivers of drinking. Participants were more receptive to pharmacotherapy when presented with medication options that did not require abstinence. Participants reported being more likely to try pharmacotherapy as part of a peer group or treatment program.CONCLUSIONS: Efforts to increase the knowledge and availability of naltrexone and harm reduction approaches, while addressing addiction- and medication-related stigma, might improve pharmacotherapy uptake for AUD and decrease hazardous drinking among MSM for whom alcohol holds social significance.

  View details for DOI 10.1016/j.abrep.2018.09.004

  View details for PubMedID 30258972

• "We don't treat your kind": Assessing HIV health needs holistically among transgender people in Jackson, Mississippi PLOS ONE Perez-Brumer, A., Nunn, A., Hsiang, E., Oldenburg, C., Bender, M., Beauchamps, L., Mena, L., MacCarthy, S. 2018; 13 (11): e0202389

  Abstract

  HIV disproportionately impacts transgender communities and the majority of new infections occur in the Southern United States. Yet, limited data exists on contextual realities of HIV vulnerability and healthcare needs among transgender individuals in the Deep South. Addressing this gap in the literature, we assess the health needs, including barriers and facilitators to accessing healthcare, including and beyond HIV, from the perspective of transgender men and women in Mississippi. Between June-August 2014, in-depth, semi-structured qualitative interviews (n = 14) were conducted with adult transgender persons at an LGBT healthcare setting in Jackson, Mississippi. In-depth interviews lasted between 60-90 minutes and followed semi-structured format (themes probed: HIV vulnerability, healthcare needs, and availability of gender-affirming medical care). Audio files were transcribed verbatim and analyzed using Dedoose (v.6.1.18). Among participants (mean age = 23.3 years, standard deviation = 4.98), 43% identified as a transgender man or on a transmasculine spectrum, 43% as Black, and 21% self-reported living with HIV. HIV-related services were frequently described as the primary gateway to accessing healthcare needs. Nonetheless, participants' primary health concerns were: gender affirmation processes (hormones, silicone, binding/packing); mental health; and drug/alcohol use. Stigma and discrimination were commonly reported in healthcare settings and health-related information was primarily attained through social networks and online resources. Results highlight gender identity alongside race and pervasive marginalization as key social determinants of transgender health in Mississippi. As Mississippi is one of several states actively debating transgender access to public accommodations, findings underscore the need to treat transgender health as a holistic and multidimensional construct, including, but moving beyond, HIV prevention and care.

  View details for DOI 10.1371/journal.pone.0202389

  View details for Web of Science ID 000449027600005

  View details for PubMedID 30383751

  View details for PubMedCentralID PMC6211621

• Oxytocin-Enhanced Motivational Interviewing Group Therapy for Methamphetamine Use Disorder in Men Who Have Sex With Men: Preliminary Results From a Randomized Controlled Trial Stauffer, C., Moschetto, J., McKernan, S., Hsiang, E., Woolley, J. ELSEVIER SCIENCE INC. 2018: S230-S231

  View details for DOI 10.1016/j.biopsych.2018.02.597

  View details for Web of Science ID 000432466300574