Amey AL, Bishai D. Measuring the quality of medical care for women who experience sexual assault with data from the National Hospital Ambulatory Medical Care Survey. Ann Emerg Med 2002; 29:631-638.
According to this study, sexual assault victims are not receiving complete treatment as recommended by Centers for Disease Control and Prevention Guidelines. Researchers from Johns Hopkins Bloomberg School of Public Health in Baltimore analyzed seven years of data reported to the National Hospital Ambulatory Medical Care Survey by a nationally representative sample of EDs. Although the number of rapes reported by EDs for the years 1992 through 1998 is consistent with the number of rapes reported to law enforcement, the study found that a large portion of the patients were not given appropriate treatment.
Here are key findings:
• Although Centers for Disease Control and Pre-vention guidelines recommend screening for sexually transmitted diseases (STDs) and HIV for sexual assault patients, 65% of patients were not screened for STDs, and 77% were not screened for HIV. Of adult patients 18 and older, 21% received neither screening nor treatment.
• Fewer than half of eligible women received emergency contraception, although this is recommended by the American College of Obstetricians and Gynecolo-gists for women at risk of pregnancy.
"On the basis of our evidence, there are a significant number of adult women who do not receive proper screening and treatment to prevent pregnancy and STDs after sexual assault," write the researchers.
"This points to a need for hospital EDs to develop better programs for medical management of patients experiencing sexual assault or to refer patients to other hospitals that have developed this expertise," they explain. (For more information on this topic, see "Do sex assault victims receive adequate care? If not, you risk fines, violations," ED Management, June 2002, p. 61.)
Thornquist L, Biros M, Olander R, et al. Health care utilization of chronic inebriates. Acad Emerg Med 2002; 9:300-308.
County programs can reduce ED use for most chronic inebriates, but serious medical illness or injury in a small group of these patients had a major impact on resource utilization, says this study from the Hennepin County Medical Center in Minneapolis. The facility’s ED receives approximately 4,500 visits each year, or 12 per day, for patients with acute alcohol intoxication or altered mental status due to alcohol. To address this problem, the county developed three programs to reduce ED utilization, including a housing program and intensive street case management.
The study looked at 92 chronic inebriates, seven of whom had severe illness or injuries. The researchers found significant reductions in the numbers of yearly medical visits for this group of patients. However, the mean charge for medical care of this group did not decrease, due to a small number of catastrophic medical events for a few study patients that skewed the overall results for the group as a whole.
"Although it is tempting to disregard these outliers in the final medical cost-savings analysis, they are a medical reality in this patient group," the researchers conclude. They recommend the following to manage chronic inebriates:
- developing a countywide system to promote appropriate use of the ED, while still providing a medically safe environment for patient;
- involving the ED in development of programs to address the medical and social needs of this group;
- developing programs that address current health needs of these patients, with the awareness that a significant number will not respond to rehabilitation.
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