Preventative Care in the Emergency Department — A Delicate Balance0

According to a recent study published in the Journal of the American Medical Association, between 1997 and 2007, Emergency Department (ED) visit rates increased nationwide from 352.8 to 390.5 per 1000 persons. These EDs exist as critical foundations in the nation’s ability to deliver health care to everyone, regardless of insurance, ability to pay or even immigration status. The Institute of Medicine has referred to EDs as “the Safety Net of the Safety Net . . . the provider of last resort for millions of patients who are uninsured or lack adequate access to care from community providers.”

A new study at the Stanford University Center for Health Policy finds that 90 percent of these same EDs also offer preventive-care services.  The study’s lead author, M. Kit Delgado, M.D., was also somewhat surprised at the detailed findings in the National Survey of Preventative Health Services in US Emergency Departments.  Dr. Delgado, an emergency medicine physician at Stanford, stated:  “It’s more evidence that our health-care system is dysfunctional. Emergency departments have evolved to compensate as the ‘safety net’ for patients failed by a system unable to guarantee accessible primary care.”

EDs, as the name would indicate, are designed to address and treat emergency medical conditions. Any focus on the underlying illnesses and unhealthy behaviors presenting at the ED must be done without compromising their primary mission — the medical emergencies. Furthermore, the financial burdens faced by EDs nationwide leave little room to provide preventative services for which the government and insurance companies generally do not reimburse.

In the interest making these medical facilities more sustainable, there are some resources available such as designed to strengthen the relationship between EDs and the communities they serve (and at the same time provide education to the community about what to expect in the event of a hospital stay). The balance between treating medical emergencies and providing preventative care is delicate at best, however. The study recommends additional research on the cost effectiveness of these preventative services in the ED, as well as the impact on the delivery of emergency medicine.

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