Characteristics of US Emergency Departments That Offer Routine Human Immunodeficiency Virus Screening
Characteristics of US Emergency Departments That Offer Routine Human Immunodeficiency Virus Screening
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DOI：
10.1111/j.1553-2712.2012.01401.x
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发表时间：
2012-08-01
影响因子：
4.4
通讯作者：
Camargo, Carlos A., Jr.
中科院分区：
文献类型：
--
作者：
Berg, Laura J.;Delgado, M. Kit;Camargo, Carlos A., Jr.
学术急诊医学2012; 19：894900（c）2012学术急诊医学学会摘要目标：急诊科（艾德）特征、艾德主任对预防服务的看法与人类免疫缺陷病毒（HIV）筛查的可用性之间的关联尚不清楚。作者假设，在调整艾德的操作和人口统计学特征后，教学医院的地位将与可用性增加相关，而艾德拥挤和艾德主任同意筛查障碍将与可用性降低相关。研究方法：这是一个次要的，横截面分析先前收集的数据，从2008年至2009年有关艾德预防服务的可用性。数据来自随机抽样的277个ED，其中艾德主任提供的信息，艾德的特点和艾滋病毒筛查的可用性和评级的五个障碍，提供预防服务。艾滋病毒筛查和教学医院和拥挤状态，艾德量，城乡位置，所有权，地理区域，患者人口统计学，国家艾滋病毒检测同意法，和艾德主任意见的障碍，提供预防服务的可用性之间的关联进行了单变量分析和多变量logistic回归模型确定。结果：19%的抽样ED提供艾滋病毒筛查。教学医院比非教学医院更频繁地提供HIV筛查（38%对18%; p = 0.03），但在多变量模型中调整其他特征后，这种关联并不显著（相对风险比[RR] = 2.07，95%置信区间[CI] = 0.91至3.59）。艾德拥挤也与筛查可用性无显著相关性（RR = 0.66，95%CI = 0.34 - 1.21）。然而，公有制（RR = 2.13，95%CI = 1.28 - 3.14），24小时社会工作（RR = 1.87，95%CI = 1.02 ~ 2.99），未参保人群=35%（RR = 2.48，95% CI = 1.39 - 3.69），当地非白人少数民族人口百分比增加（RR = 1.14/10%，95%CI = 1.02 - 1.26）和州法律允许选择退出同意检测（RR = 1.76，95%CI = 1.01 - 2.74）与多变量分析中筛查可用性增加相关。主任担心增加费用的ED与筛查可用性下降相关（RR = 0.45，95%CI = 0.23至0.85）。结论：在调整其他艾德操作和人口统计学特征后，艾德拥挤和教学医院附属关系与HIV筛查的可用性无关。主任担心预防服务费用的急诊室不太可能提供常规艾滋病毒筛查。解决艾德董事对艾德预防服务增加成本的担忧，增加社会工作的可用性，并实施与疾病控制和预防中心（CDC）建议一致的检测法律，可能会促进更多地采用艾德艾滋病毒筛查。
ACADEMIC EMERGENCY MEDICINE 2012; 19:894900 (c) 2012 by the Society for Academic Emergency Medicine Abstract Objectives: The association between emergency department (ED) characteristics, ED directors perceptions of preventive services, and the availability of human immunodeficiency virus (HIV) screening are unknown. The authors hypothesized that, after adjusting for ED operational and demographic characteristics, teaching hospital status would be associated with increased availability, and ED crowding and ED director agreement with barriers to screening would be associated with decreased availability. Methods: This was a secondary, cross-sectional analysis on previously collected data from 2008 to 2009 regarding availability of ED preventive services. Data were obtained from a random sample of 277 EDs in which ED directors provided information on ED characteristics and availability of HIV screening and rated five barriers to providing preventive services. The association between the availability of HIV screening and teaching hospital and crowding status, ED volume, urbanrural location, ownership, geographic region, patient demographics, state HIV testing consent laws, and ED director opinions on barriers to providing preventive services were determined in univariate analyses and a multivariate logistic regression model. Results: Nineteen percent of the sampled EDs offer HIV screening. Teaching hospitals offer HIV screening more frequently than nonteaching hospitals (38% vs. 18%; p = 0.03), but after adjusting for other characteristics in a multivariate model, this association was not significant (relative risk ratio [RR] = 2.07, 95% confidence interval [CI] = 0.91 to 3.59). ED crowding also was not significantly associated with screening availability (RR = 0.66, 95% CI = 0.34 to 1.21). However, public ownership (RR = 2.13, 95% CI = 1.28 to 3.14), 24-hour social work (RR = 1.87, 95% CI = 1.02 to 2.99), uninsured population =35% (RR = 2.48, 95% CI = 1.39 to 3.69), increased local nonwhite minority population percentage (RR = 1.14 per 10%, 95% CI = 1.02 to 1.26), and state laws allowing opt-out consent for testing (RR = 1.76, 95% CI = 1.01 to 2.74) were associated with increased availability of screening in multivariable analysis. EDs whose directors were concerned about added costs were associated with decreased availability of screening (RR = 0.45, 95% CI = 0.23 to 0.85). Conclusions: After adjusting for other ED operational and demographic characteristics, ED crowding and teaching hospital affiliation were not independently associated with the availability of HIV screening. EDs whose directors were concerned about the cost of preventive services were less likely to provide routine HIV screening. Addressing ED directors concerns about the added costs of ED preventive services, increasing social work availability, and implementing testing laws consistent with Centers for Disease Control and Prevention (CDC) recommendations may facilitate increased adoption of ED HIV screening.