Skip to main content
NCBI home page
Public Health Reports logoLink to Public Health Reports
. 2005 May-Jun;120(3):259–265. doi: 10.1177/003335490512000307

Health department collaboration with emergency departments as a model for public health programs among at-risk populations.

Michael S Lyons 1, Christopher J Lindsell 1, Holly K Ledyard 1, Peter T Frame 1, Alexander T Trott 1
PMCID: PMC1497724  PMID: 16134565

Abstract

OBJECTIVES: 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. METHOD: 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. RESULTS: 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. CONCLUSIONS: Public health programs can operate effectively in the ED. EDs should have a rapidly expanding role in the national public health system.

Full Text

The Full Text of this article is available as a PDF (140.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anglin Deirdre, Sachs Carolyn. Preventive care in the emergency department: screening for domestic violence in the emergency department. Acad Emerg Med. 2003 Oct;10(10):1118–1127. doi: 10.1111/j.1553-2712.2003.tb00585.x. [DOI] [PubMed] [Google Scholar]
  2. Babcock Irvin C., Wyer P. C., Gerson L. W. Preventive care in the emergency department, Part II: Clinical preventive services--an emergency medicine evidence-based review. Society for Academic Emergency Medicine Public Health and Education Task Force Preventive Services Work Group. Acad Emerg Med. 2000 Sep;7(9):1042–1054. doi: 10.1111/j.1553-2712.2000.tb02098.x. [DOI] [PubMed] [Google Scholar]
  3. Beckwith Curt G., Lally Michelle A., Flanigan Timothy P. Routine HIV testing among inpatients. Arch Intern Med. 2002 Oct 28;162(19):2252–2253. doi: 10.1001/archinte.162.19.2252. [DOI] [PubMed] [Google Scholar]
  4. Bernstein E., Goldfrank L. R., Kellerman A. L., Hargarten S. W., Jui J., Fish S. S., Herbert B. H., Flores C., Caravati M. E., Krishel S. A public health approach to emergency medicine: preparing for the twenty-first century. Acad Emerg Med. 1994 May-Jun;1(3):277–286. doi: 10.1111/j.1553-2712.1994.tb02446.x. [DOI] [PubMed] [Google Scholar]
  5. Callahan James M., Reed David, Meguid Victoria, Wojcik Susan, Reed Katie. Utility of an immunization registry in a pediatric emergency department. Pediatr Emerg Care. 2004 May;20(5):297–301. doi: 10.1097/01.pec.0000125657.05196.55. [DOI] [PubMed] [Google Scholar]
  6. Castrucci Brian C., Kamb Mary L., Hunt Ken. Assessing the Center for Disease Control and Prevention's 1994 HIV counseling, testing, and referral: standards and guidelines: how closely does practice conform to existing recommendations? Sex Transm Dis. 2002 Jul;29(7):417–421. doi: 10.1097/00007435-200207000-00010. [DOI] [PubMed] [Google Scholar]
  7. Clancy C. M., Eisenberg J. M. Emergency medicine in population-based systems of care. Ann Emerg Med. 1997 Dec;30(6):800–803. doi: 10.1016/s0196-0644(97)70052-0. [DOI] [PubMed] [Google Scholar]
  8. Coil Clinton J., Haukoos Jason S., Witt Mallory D., Wallace Roger C., Lewis Roger J. Evaluation of an emergency department referral system for outpatient HIV testing. J Acquir Immune Defic Syndr. 2004 Jan 1;35(1):52–55. doi: 10.1097/00126334-200401010-00007. [DOI] [PubMed] [Google Scholar]
  9. Colfax Grant N., Buchbinder Susan P., Cornelisse Peter G. A., Vittinghoff Eric, Mayer Kenneth, Celum Connie. Sexual risk behaviors and implications for secondary HIV transmission during and after HIV seroconversion. AIDS. 2002 Jul 26;16(11):1529–1535. doi: 10.1097/00002030-200207260-00010. [DOI] [PubMed] [Google Scholar]
  10. Cunningham Rebecca, Walton Maureen A., Maio Ronald F., Blow Fredric C., Weber James E., Mirel Lisa. Violence and substance use among an injured emergency department population. Acad Emerg Med. 2003 Jul;10(7):764–775. doi: 10.1111/j.1553-2712.2003.tb00071.x. [DOI] [PubMed] [Google Scholar]
  11. Freedberg K. A., Samet J. H. Think HIV: why physicians should lower their threshold for HIV testing. Arch Intern Med. 1999 Sep 27;159(17):1994–2000. doi: 10.1001/archinte.159.17.1994. [DOI] [PubMed] [Google Scholar]
  12. Glauser J. Rationing and the role of the emergency department as society's safety net. Acad Emerg Med. 2001 Nov;8(11):1101–1106. doi: 10.1111/j.1553-2712.2001.tb01123.x. [DOI] [PubMed] [Google Scholar]
  13. Goggin M. A., Davidson A. J., Cantril S. V., O'Keefe L. K., Douglas J. M. The extent of undiagnosed HIV infection among emergency department patients: results of a blinded seroprevalence survey and a pilot HIV testing program. J Emerg Med. 2000 Jul;19(1):13–19. doi: 10.1016/s0736-4679(00)00175-x. [DOI] [PubMed] [Google Scholar]
  14. Gordon J. A., Billings J., Asplin B. R., Rhodes K. V. Safety net research in emergency medicine: proceedings of the Academic Emergency Medicine Consensus Conference on "The Unraveling Safety Net". Acad Emerg Med. 2001 Nov;8(11):1024–1029. doi: 10.1111/j.1553-2712.2001.tb01110.x. [DOI] [PubMed] [Google Scholar]
  15. Gordon J. A., Goldfrank L. R., Andrulis D. P., D'Alessandri R. M., Kellermann A. L. Emergency department initiatives to improve the public health. Acad Emerg Med. 1998 Sep;5(9):935–937. doi: 10.1111/j.1553-2712.1998.tb02827.x. [DOI] [PubMed] [Google Scholar]
  16. Hogg R. S., Heath K. V., Yip B., Craib K. J., O'Shaughnessy M. V., Schechter M. T., Montaner J. S. Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA. 1998 Feb 11;279(6):450–454. doi: 10.1001/jama.279.6.450. [DOI] [PubMed] [Google Scholar]
  17. Irvin C. B. Public health preventive services, surveillance, and screening: the emergency Department's potential. Acad Emerg Med. 2000 Dec;7(12):1421–1423. doi: 10.1111/j.1553-2712.2000.tb00501.x. [DOI] [PubMed] [Google Scholar]
  18. Kahn J. O., Walker B. D. Acute human immunodeficiency virus type 1 infection. N Engl J Med. 1998 Jul 2;339(1):33–39. doi: 10.1056/NEJM199807023390107. [DOI] [PubMed] [Google Scholar]
  19. Karon J. M., Fleming P. L., Steketee R. W., De Cock K. M. HIV in the United States at the turn of the century: an epidemic in transition. Am J Public Health. 2001 Jul;91(7):1060–1068. doi: 10.2105/ajph.91.7.1060. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Kelen G. D., Fritz S., Qaqish B., Brookmeyer R., Baker J. L., Kline R. L., Cuddy R. M., Goessel T. K., Floccare D., Williams K. A. Unrecognized human immunodeficiency virus infection in emergency department patients. N Engl J Med. 1988 Jun 23;318(25):1645–1650. doi: 10.1056/NEJM198806233182503. [DOI] [PubMed] [Google Scholar]
  21. Kelen G. D., Hexter D. A., Hansen K. N., Humes R., Vigilance P. N., Baskerville M., Quinn T. C. Feasibility of an emergency department-based, risk-targeted voluntary HIV screening program. Ann Emerg Med. 1996 Jun;27(6):687–692. doi: 10.1016/s0196-0644(96)70184-1. [DOI] [PubMed] [Google Scholar]
  22. Kelen G. D., Hexter D. A., Hansen K. N., Tang N., Pretorius S., Quinn T. C. Trends in human immunodeficiency virus (HIV) infection among a patient population of an inner-city emergency department: implications for emergency department-based screening programs for HIV infection. Clin Infect Dis. 1995 Oct;21(4):867–875. doi: 10.1093/clinids/21.4.867. [DOI] [PubMed] [Google Scholar]
  23. Kelen G. D., Shahan J. B., Quinn T. C. Emergency department-based HIV screening and counseling: experience with rapid and standard serologic testing. Ann Emerg Med. 1999 Feb;33(2):147–155. doi: 10.1016/s0196-0644(99)70387-2. [DOI] [PubMed] [Google Scholar]
  24. Klein Daniel, Hurley Leo B., Merrill Deanna, Quesenberry Charles P., Jr, Consortium for HIV/AIDS Interregional Research Review of medical encounters in the 5 years before a diagnosis of HIV-1 infection: implications for early detection. J Acquir Immune Defic Syndr. 2003 Feb 1;32(2):143–152. doi: 10.1097/00126334-200302010-00005. [DOI] [PubMed] [Google Scholar]
  25. La Croix S. J., Russo G. A cost-benefit analysis of voluntary routine HIV-antibody testing for hospital patients. Soc Sci Med. 1996 May;42(9):1259–1272. doi: 10.1016/0277-9536(95)00221-9. [DOI] [PubMed] [Google Scholar]
  26. Lindsay M. K., Grant J., Peterson H. B., Risby J., Williams H., Klein L. Human immunodeficiency virus infection among patients in a gynecology emergency department. Obstet Gynecol. 1993 Jun;81(6):1012–1015. [PubMed] [Google Scholar]
  27. Llovera Ingrid, Ward Mary F., Ryan James G., LaTouche Thalia, Sama Andrew. A survey of the emergency department population and their interest in preventive health education. Acad Emerg Med. 2003 Feb;10(2):155–160. doi: 10.1111/j.1553-2712.2003.tb00034.x. [DOI] [PubMed] [Google Scholar]
  28. Lyons Michael S., Lindsell Christopher J., Trott Alexander T. Emergency department pelvic examination and Pap testing: addressing patient misperceptions. Acad Emerg Med. 2004 Apr;11(4):405–408. doi: 10.1197/j.aem.2003.10.031. [DOI] [PubMed] [Google Scholar]
  29. Manthey David E., Stopyra Jason, Askew Kim. Referral of emergency department patients for pneumococcal vaccination. Acad Emerg Med. 2004 Mar;11(3):271–275. doi: 10.1111/j.1553-2712.2004.tb02208.x. [DOI] [PubMed] [Google Scholar]
  30. McCaig Linda F., Burt Catharine W. National Hospital Ambulatory Medical Care Survey: 2001 emergency department summary. Adv Data. 2003 Jun 4;(335):1–29. [PubMed] [Google Scholar]
  31. McCaig Linda F., Burt Catharine W. National Hospital Ambulatory Medical Care Survey: 2002 emergency department summary. Adv Data. 2004 Mar 18;(340):1–34. [PubMed] [Google Scholar]
  32. McCusker Jane, Dendukuri Nandini, Tousignant Pierre, Verdon Josée, Poulin de Courval Louise, Belzile Eric. Rapid two-stage emergency department intervention for seniors: impact on continuity of care. Acad Emerg Med. 2003 Mar;10(3):233–243. doi: 10.1111/j.1553-2712.2003.tb01997.x. [DOI] [PubMed] [Google Scholar]
  33. McLean Samuel A., Blow Frederic C., Walton Maureen A., Gregor Mary Ann, Barry Kristen L., Maio Ronald F., Knutzen Steven R. Rates of at-risk drinking among patients presenting to the emergency department with occupational and nonoccupational injury. Acad Emerg Med. 2003 Dec;10(12):1354–1361. doi: 10.1111/j.1553-2712.2003.tb00010.x. [DOI] [PubMed] [Google Scholar]
  34. Parsa M., Walsh M. J. Ethics seminars: HIV testing, consent, and physician responsibilities. Acad Emerg Med. 2001 Dec;8(12):1197–1199. doi: 10.1111/j.1553-2712.2001.tb01140.x. [DOI] [PubMed] [Google Scholar]
  35. Peckler Brad. Emergency department HIV testing: sounds good, but...? Acad Emerg Med. 2003 Dec;10(12):1415–1417. doi: 10.1111/j.1553-2712.2003.tb00023.x. [DOI] [PubMed] [Google Scholar]
  36. Pollock D. A., Lowery D. W., O'brien P. M. Emergency medicine and public health: new steps in old directions. Ann Emerg Med. 2001 Dec;38(6):675–683. doi: 10.1067/mem.2001.119457. [DOI] [PubMed] [Google Scholar]
  37. Rhodes K. V., Gordon J. A., Lowe R. A. Preventive care in the emergency department, Part I: Clinical preventive services--are they relevant to emergency medicine? Society for Academic Emergency Medicine Public Health and Education Task Force Preventive Services Work Group. Acad Emerg Med. 2000 Sep;7(9):1036–1041. doi: 10.1111/j.1553-2712.2000.tb02097.x. [DOI] [PubMed] [Google Scholar]
  38. Richardson L. D., Hwang U. Access to care: a review of the emergency medicine literature. Acad Emerg Med. 2001 Nov;8(11):1030–1036. doi: 10.1111/j.1553-2712.2001.tb01111.x. [DOI] [PubMed] [Google Scholar]
  39. Rodriguez R. M., Kreider W. J., Baraff L. J. Need and desire for preventive care measures in emergency department patients. Ann Emerg Med. 1995 Nov;26(5):615–620. doi: 10.1016/s0196-0644(95)70014-5. [DOI] [PubMed] [Google Scholar]
  40. Rothman Richard E. Current Centers for Disease Control and Prevention guidelines for HIV counseling, testing, and referral: critical role of and a call to action for emergency physicians. Ann Emerg Med. 2004 Jul;44(1):31–42. doi: 10.1016/j.annemergmed.2004.01.016. [DOI] [PubMed] [Google Scholar]
  41. Rothman Richard E., Ketlogetswe Kerunne S., Dolan Teresa, Wyer Peter C., Kelen Gabor D. Preventive care in the emergency department: should emergency departments conduct routine HIV screening? a systematic review. Acad Emerg Med. 2003 Mar;10(3):278–285. doi: 10.1111/j.1553-2712.2003.tb02004.x. [DOI] [PubMed] [Google Scholar]
  42. Schacker T., Collier A. C., Hughes J., Shea T., Corey L. Clinical and epidemiologic features of primary HIV infection. Ann Intern Med. 1996 Aug 15;125(4):257–264. doi: 10.7326/0003-4819-125-4-199608150-00001. [DOI] [PubMed] [Google Scholar]
  43. Schneider S. M., Hamilton G. C., Moyer P., Stapczynski J. S. Definition of emergency medicine. Acad Emerg Med. 1998 Apr;5(4):348–351. doi: 10.1111/j.1553-2712.1998.tb02720.x. [DOI] [PubMed] [Google Scholar]
  44. Slobodkin D., Kitlas J. L., Zielske P. G. A test of the feasibility of pneumococcal vaccination in the emergency department. Acad Emerg Med. 1999 Jul;6(7):724–727. doi: 10.1111/j.1553-2712.1999.tb00443.x. [DOI] [PubMed] [Google Scholar]
  45. Stern R. S., Weissman J. S., Epstein A. M. The emergency department as a pathway to admission for poor and high-cost patients. JAMA. 1991 Oct 23;266(16):2238–2243. [PubMed] [Google Scholar]
  46. Suyama Joe, Sztajnkrycer Matthew, Lindsell Christopher, Otten Edward J., Daniels Judith M., Kressel Amy B. Surveillance of infectious disease occurrences in the community: an analysis of symptom presentation in the emergency department. Acad Emerg Med. 2003 Jul;10(7):753–763. doi: 10.1111/j.1553-2712.2003.tb00070.x. [DOI] [PubMed] [Google Scholar]
  47. Taylor T. B. Threats to the health care safety net. Acad Emerg Med. 2001 Nov;8(11):1080–1087. doi: 10.1111/j.1553-2712.2001.tb01119.x. [DOI] [PubMed] [Google Scholar]
  48. Vanhems P., Hughes J., Collier A. C., Vizzard J., Perrin L., Cooper D. A., Hirschel B., Corey L. Comparison of clinical features, CD4 and CD8 responses among patients with acute HIV-1 infection from Geneva, Seattle and Sydney. AIDS. 2000 Mar 10;14(4):375–381. doi: 10.1097/00002030-200003100-00010. [DOI] [PubMed] [Google Scholar]
  49. Vogt T. M., Hollis J. F., Lichtenstein E., Stevens V. J., Glasgow R., Whitlock E. The medical care system and prevention: the need for a new paradigm. HMO Pract. 1998 Mar;12(1):5–13. [PubMed] [Google Scholar]
  50. Wilson S. R., Mitchell C., Bradbury D. R., Chavez J. Testing for HIV: current practices in the academic ED. Am J Emerg Med. 1999 Jul;17(4):354–356. doi: 10.1016/s0735-6757(99)90085-2. [DOI] [PubMed] [Google Scholar]
  51. Zonfrillo Mark R., Mello Michael J., Palmisciano Lynne M. Usefulness of computerized pediatric motor vehicle safety discharge instructions. Acad Emerg Med. 2003 Oct;10(10):1131–1133. doi: 10.1111/j.1553-2712.2003.tb00587.x. [DOI] [PubMed] [Google Scholar]

Articles from Public Health Reports are provided here courtesy of SAGE Publications

RESOURCES