University of Maryland School of Medicine, Baltimore, Maryland.
West J Emerg Med. 2024 May;25(3):415-422. doi: 10.5811/westjem.18316.
Emergency departments (ED) in the United States serve a dual role in public health: a portal of entry to the health system and a safety net for the community at large. Public health officials often target the ED for public health interventions due to the perception that it is uniquely able to reach underserved populations. However, under time and resource constraints, emergency physicians and public health officials must make calculated decisions in choosing which interventions in their local context could provide maximal impact to achieve public health benefit. We identify how decisions regarding public health interventions are affected by considerations of cost, time, and available personnel, and further consider the role of local community needs, health department goals, and political environment. We describe a sample of ED-based public health interventions and demonstrate how to use a proposed framework to assess interventions. We posit a series of questions and variables to consider: local disease prevalence; ability of the ED to perform the intervention; relative efficacy of the ED vs community partnerships as the primary intervention location; and expected outcomes. In using this framework, clinicians should be empowered to improve the public health in their communities.
既是进入卫生系统的门户，也是广大社区的安全网。由于公共卫生官员认为急诊科具有独特的能力可以接触到服务不足的人群，因此他们经常将急诊科作为公共卫生干预的目标。然而，在时间和资源有限的情况下，急诊医生和公共卫生官员必须在当地环境中做出明智的决策，选择哪些干预措施能够产生最大的影响，从而实现公共卫生效益。我们确定了成本、时间和可用人员等因素如何影响公共卫生干预措施的决策，并进一步考虑了当地社区需求、卫生部门目标和政治环境的作用。我们描述了一些基于急诊科的公共卫生干预措施，并展示了如何使用拟议的框架来评估干预措施。我们提出了一系列需要考虑的问题和变量：当地疾病流行率；急诊科执行干预措施的能力；急诊科与社区伙伴关系作为主要干预地点的相对效果；以及预期结果。通过使用这个框架，临床医生应该能够在他们的社区中改善公共卫生。
