Lyons Michael S, Lindsell Christopher J, Ledyard Holly K, Frame Peter T, Trott Alexander T
Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Public Health Rep. 2005 May-Jun;120(3):259-65. doi: 10.1177/003335490512000307.
Accessing at-risk and underserved populations for intervention remains a major obstacle for public health programs. Emergency departments (EDs) care for patients not otherwise interacting with the health care system, and represent a venue for such programs. A variety of perceived and actual barriers inhibit widespread implementation of ED-based public health programs. Collaboration between local health departments and EDs may overcome such barriers. The goal of this study was to assess the effectiveness of a health department-funded, ED-based public health program in comparison with other similar community-based programs through analysis of data reported by health department-funded HIV counseling and testing centers in one Ohio county.
Data for HIV counseling and testing at publicly funded sites in southwestern Ohio from January 1999 through December 2002 were obtained from the Ohio Department of Health. Demographic and risk-factor profiles were compared between the counseling and testing program located in the ED of a large, urban teaching hospital and the other publicly funded centers in the same county.
A total of 26,382 patients were counseled and tested; 5,232 were ED patients, and 21,150 were from community sites. HIV positivity was 0.86% (95% confidence interval [CI] 0.64%, 1.15%) in the ED and 0.65% (95% CI 0.55%, 0.77%) elsewhere. The ED program accounted for 19.8% of all tests and 24.7% of all positive results. The ED notified 77.3% of individuals testing positive and 84.4% of individuals testing negative. At community program centers, 88.3% of patients testing positive and 63.8% of patients testing negative were notified of results. All ED patients notified of positive status were successfully referred to infectious disease specialists.
Public health programs can operate effectively in the ED. EDs should have a rapidly expanding role in the national public health system.
让处于风险中的人群和未得到充分服务的人群获得干预措施，仍然是公共卫生项目面临的主要障碍。急诊科为那些未与医疗保健系统有其他接触的患者提供护理，是此类项目的一个场所。各种感知到的和实际存在的障碍阻碍了基于急诊科的公共卫生项目的广泛实施。地方卫生部门与急诊科之间的合作可能会克服这些障碍。本研究的目的是通过分析俄亥俄州一个县由卫生部门资助的艾滋病毒咨询和检测中心报告的数据，评估一项由卫生部门资助、基于急诊科的公共卫生项目与其他类似社区项目相比的有效性。
获取了1999年1月至2002年12月俄亥俄州西南部公共资助场所的艾滋病毒咨询和检测数据，这些数据来自俄亥俄州卫生部。对位于一家大型城市教学医院急诊科的咨询和检测项目与同一县的其他公共资助中心的人口统计学和风险因素概况进行了比较。
共有26382名患者接受了咨询和检测；其中5232名是急诊科患者，21150名来自社区场所。急诊科的艾滋病毒阳性率为0.86%（95%置信区间[CI]0.64%，1.15%），其他地方为0.65%（95%CI0.55%，0.77%）。急诊科项目占所有检测的19.8%，占所有阳性结果的24.7%。急诊科通知了77.3%检测呈阳性的个体和84.4%检测呈阴性的个体。在社区项目中心，88.3%检测呈阳性的患者和63.8%检测呈阴性的患者收到了检测结果通知。所有被告知检测呈阳性的急诊科患者都成功转诊给了传染病专家。
公共卫生项目可以在急诊科有效开展。急诊科在国家公共卫生系统中的作用应迅速扩大。
