Author(s): Lowenstein SR, KoziolMcLain J, Thompson M, Bernstein E, Greenberg K,
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Abstract BACKGROUND: Many people rely on EDs for routine health care. Often, however, screening and counseling for health risks are not provided. OBJECTIVE: To determine prevalence rates of chronic disease and injury risk factors and access to routine health care in a random sample of ED patients in 3 cities. METHODS: A prospective survey was conducted at 3 hospital EDs in Akron, OH, Boston, MA, and Denver, CO. A modified version of the national Behavioral Risk Factor Surveillance Survey was administered by trained researchers to a convenience sample of non-critically ill patients during randomly selected shifts. RESULTS: Of 1,143 eligible patients, 923 (81\%) agreed to participate. Their mean age was 39 (range = 17-96) years. Most were female (58\%), white (60\%), and unmarried (68\%). Thirty-eight percent had no access to primary care. Injury-prone behaviors were prevalent: 53\% of the respondents did not wear seat belts regularly; 15\% had no working smoke detector; 3\% kept loaded, unlocked handguns in their homes; 11\% had attempted suicide; 23\% had a positive CAGE screen for alcoholism; 3\% had operated a motor vehicle in the preceding month while alcohol-intoxicated; and 11\% had ridden in an automobile with an intoxicated driver. Cancer and chronic disease risks were also common: 48\% smoked; 16\% had not received a blood pressure check in the preceding year; and 4\% reported unsafe sexual practices. Among women aged > 50 years, 42\% had not received a Pap test in the prior 2 years and 14\% had never had mammography. Many prevalence rates and access to care varied among the 3 sites. However, for most risk factors, prevalence rates did not differ in patients with and without access to primary health care. CONCLUSIONS: ED patients have high rates of injury and chronic disease risks, and many have no other source of routine health care. Research is needed to determine whether ED-based programs, designed to reduce injury and chronic disease risks, are feasible and cost-effective.
This article was published in Acad Emerg Med
and referenced in Journal of Addiction Research & Therapy