Consistent high prevalence of undiagnosed blood-borne virus infection in patients attending large urban emergency departments in England.
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ABSTRACT:
SUBMITTER: Hopkins MJ
PROVIDER: S-EPMC6972612 | biostudies-literature | 2020 Jan
REPOSITORIES: biostudies-literature
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Consistent high prevalence of undiagnosed blood-borne virus infection in patients attending large urban emergency departments in England.
Hopkins Mark J MJ Todd Stacy S Beadsworth Mike M Anderson Charlotte C Mohamed Zameer Z Muir David D Vivancos Roberto R Brown Ashley S AS Ruf Murad M Chawla Anu A
Journal of viral hepatitis 20191001 1
Understanding local viral hepatitis and HIV epidemiology is essential if WHO elimination targets are to be achieved. We demonstrate a consistently high prevalence of undiagnosed active infection in urban emergency department attendees in England, with variations in local risk groups crucial to informing targeted testing initiatives. ...[more]
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Project description: Not available
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Project description:Introduction:Attempts to reduce low-value hospital care often focus on emergency department (ED) hospitalizations. We compared rural and urban EDs in Michigan on resources designed to reduce avoidable admissions. Methods:A cross-sectional, web-based survey was emailed to medical directors and/or nurse managers of the 135 hospital-based EDs in Michigan. Questions included presence of clinical pathways, services to reduce admissions, and barriers to connecting patients to outpatient services. We performed chi-squared comparisons, regression modeling, and predictive margins. Results:Of 135 EDs, 64 (47%) responded with 33 in urban and 31 in rural counties. Clinical pathways were equally present in urban and rural EDs (67% vs 74%, p=0.5). Compared with urban EDs, rural EDs reported greater access to extended care facilities (21% vs 52%, p=0.02) but less access to observation units (52% vs 35%, p=0.04). Common barriers to connecting ED patients to outpatient services exist in both settings, including lack of social support (88% and 76%, p=0.20), and patient/family preference (68% and 68%, p=1.0). However, rural EDs were more likely to report time required for care coordination (88% vs 66%, p=0.05) and less likely to report limitations to home care (21% vs 48%, p=0.05) as barriers. In regression modeling, ED volume was predictive of the presence of clinical pathways rather than rurality. Conclusion:While rural-urban differences in resources and barriers exist, ED size rather than rurality may be a more important indicator of ability to reduce avoidable hospitalizations.
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