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EDs vary in HIV screening practices, other preventive services
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Nearly 75% of ED directors said cost could inhibit them from offering preventive services, according to study results.
Although most EDs offer preventive services, the availability of those services and the attitude of directors across the country vary greatly, according to the researchers. “The majority of EDs do not routinely offer Centers for Disease Control and Prevention-recommended HIV screening,” they wrote.
The results were observed in a random sample of 350 EDs selected from 4,874 EDs in the 2007 National Emergency Department Inventory–USA. Department directors were surveyed to determine whether the following services were available:
- Screening and referral programs for alcohol, geriatric falls, intimate partner violence, HIV, diabetes and hypertension.
- Vaccination programs for influenza and pneumococcus.
- Linkage programs to primary care and health insurance.
Directors were also asked which of these preventive services they would like to implement and to rate five potential barriers to offering preventive services in general.
The final analysis included responses from 277 EDs in 46 states.
The most frequently offered screening service among the 11 queried services was for intimate partner violence, at 66%. The least available service was HIV screening, which occurred in 19% of EDs.
Ten percent of the EDs did not offer any of the services. The median number of services offered was four.
When directors were asked about services they wanted to offer, primary care linkage was the most common answer (17%). HIV screening (2%) was the least common answer.
Smoking cessation counseling was offered in 27% of EDs. However, this service was the second most desired service among directors, at 14%.
Regarding barriers to offering preventive care, 74% of directors agreed or strongly agreed that cost was the most significant. Increased patient length of stay (64%), lack of follow-up (60%), resource shifting leading to worse patient outcomes (53%) and philosophical opposition (27%) were the other most frequently noted potential barriers.
The researchers suggested that this may be the first comprehensive portrait of preventive services offered by EDs in the United States outside of high-volume urban academic centers. “Most ED directors are not philosophically opposed to offering preventive services but are concerned with added costs, effects on ED operations and potential lack of follow-up,” they wrote.
Delgado MK. Ann Emerg Med. 2010;doi:10.1016/j.annemergmed.2010.07.015.