STANFORD, Calif. - People go to emergency departments when they've broken a leg, been stabbed or otherwise need urgent care. But a new study from the Stanford University School of Medicine finds that 90 percent of EDs nationwide also offer preventive-care services.
The high prevalence was surprising, said M. Kit Delgado, MD, the study's lead author and a postdoctoral scholar at Stanford's Center for Primary Care and Outcomes Research, and it likely stems from less-than-ideal conditions.
"It's more evidence that our health-care system is dysfunctional," said Delgado, who is also an emergency-medicine physician at Stanford Hospital & Clinics. "Emergency departments have evolved to compensate as the 'safety net' for patients failed by a system unable to guarantee accessible primary care."
Indeed, the study, to be published online Sept. 27 in the Annals of Emergency Medicine, illustrates a dilemma faced today by many emergency departments: the desire to address underlying illnesses and unhealthy behaviors without compromising the quality of acute care, which is their primary mission.
It is the first known study to provide an overall picture of the scope of preventive care in U.S. emergency departments, measuring the availability of 11 such services - including influenza vaccinations, counseling for tobacco addiction and screening for HIV - in 277 randomly sampled EDs from 46 states. The median number of preventive services offered was four.
At 66 percent, screening for domestic violence was the most common, though the study points out that it probably should have been higher. The Joint Commission, the major accrediting agency for U.S. health-care organizations, mandates hospitals and clinics to have policies and procedures for this type of screening. The figure suggests that many EDs may not be in compliance.
At 19 percent, HIV screening was the least common service. The U.S. Centers for Disease Contr
|Contact: John Sanford|
Stanford University Medical Center