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Despite little effectiveness evidence, most EDs offer preventive care

by Brendon Nafziger, DOTmed News Associate Editor | September 27, 2010
The emergency department is designed to handle patients with life-threatening injuries, but the vast majority also offer a helping-hand to patients whose preventive-care needs aren't being met elsewhere, such as screening for spousal abuse and giving flu shots.

A study published Monday in the Annals of Emergency Medicine found that nine out of 10 emergency departments surveyed offered at least some kind of preventive-care service, although many fall short of recommendations given by government agencies.

Even so, not everyone is pleased with the trend - close to half of ED directors worry preventive-care services drain resources better spent on acute care and could lead to worse patient outcomes.

"It's more evidence that our health-care system is dysfunctional," Dr. Kit Delgado, lead author of the study and an emergency-medicine doctor at Stanford Hospital & Clinics in Palo Alto, said in prepared remarks. "Emergency departments have evolved to compensate as the 'safety net' for patients failed by a system unable to guarantee accessible primary care."

The study was conducted through a mail-in survey answered by 277 directors of emergency departments around the country.

Most directors said their department offered at least one preventive service, but it varied widely. Screening and referral for intimate partner violence was the most commonly offered service, with around two-thirds of hospitals offering it. While high, this still fell short of national targets, the paper said.

"Our study suggests that one third of the nation's EDs may not be compliant with the Joint Commission mandate, which has required policies and procedures for intimate partner violence screening in hospitals and clinics since 1992," wrote the authors.

Screening for HIV was the least common, with only one out of five offering it, even though 2006 guidelines released by the Centers for Disease Control and Prevention called for all ED patients between 16 and 64 to be screened for the virus.

About one-third of directors said their department screened for and gave flu shots, one-fifth said they offer anti-smoking counseling and more than half offer high blood pressure screening and linkage to primary care clinics.

Yet, around 10 percent of EDs offered no services at all. The main reason for not offering them was cost, as the services are largely not reimbursable. Three-fourths of surveyed directors said cost was the biggest objection. Worries about ED overcrowding also led concerns, with around 64 percent fearing the services would increase length of stay and 53 percent concerned that resources would move away from acute care.