A recent study from Stanford School of Medicine has found that during a trip to the emergency room, you may very well receive a dose of preventive medicine.
Offering the first comprehensive picture of preventive care in U.S. emergency departments, the study revealed that a striking 90 percent of emergency departments (EDs) offer such services.
Lead author Mucio “Kit” Delgado, M.D., a postdoctoral scholar at Stanford’s Center for Primary Care and Outcomes Research, views this high percentage as a symptom of a deeper problem within the U.S. healthcare system: lack of access to primary care services.
“[The findings] point to the fact that we need to improve our health care system so that patients can get primary care in other places,” Delgado, who is also an emergency room physician at Stanford Hospital, said. “It’s a symptom that things aren’t working out as they should.”
The study surveyed the directors of 350 randomly selected emergency departments around the country on the services offered in their ED and their perceived barriers to offering preventive care.
The most common service provided is screening for domestic violence, offered at 66 percent of hospitals. Delgado noted that this finding is actually disconcerting, considering that the accrediting agency for U.S. hospitals mandates that emergency rooms offer this service.
Other services commonly available included influenza and pneumococcus vaccines, tobacco and alcohol addiction counseling and screening for diabetes, hypertension and HIV. The study asked about 11 different services in total.
The least commonly offered service is HIV screening, only available at 19 percent of hospitals, despite a CDC recommendation for testing at all emergency departments. Delgado suggested that the low access rate was due to the high cost of implementing the screening.
“That’s not surprising because it does take a huge amount of effort to be able to do that [HIV screening] effectively,” he said.
ED directors saw cost, increased length of patient stay and lack of follow-up as the top barriers to offering preventive care services in their ED. Almost 75 percent of ED directors had no philosophical opposition to offering preventive services, but rather saw it as an issue of resources.
Robert Norris, chief of emergency medicine at Stanford Hospital, concurred that cost serves as a primary determinant of services.
“When you’re in a resource-constrained environment, you have to pick and choose,” he said in a statement.
Delgado emphasized that although these services help patients, they may be misplaced. Preventive care services can draw money and time away from patients arriving with true emergencies, increasing wait lines and costs.
“You have to balance that with the fact that you’re mainly there to provide acute care, and you can’t do anything to compromise that mission.”
Contact Julia Brownell at [email protected].