Health promotion and disease prevention in the emergency department: a feasibility study.
BACKGROUND
Health promotion and disease prevention have been increasingly recognized as activities that may be within the scope of emergency medicine. The purpose of this feasibility study was to identify health risks and offer immediate interventions to adult patients who have drug and/or alcohol problems, incomplete immunization, are overdue for a Pap (Papanicolaou) smear, and/or are smokers.


METHODS
The study took place in a busy tertiary Emergency Department (ED) serving an inner-city population with a significant proportion of patients who are homeless, substance abusers, working poor, and/or recent immigrants. A convenience sample of patients completed a computer-based health-risk survey. Trained health promotion nurses offered appropriate interventions to patients following review and discussion of their self-reported data. Interventions included counseling for problem drinking, substance abuse, and smoking cessation, screening for cervical cancer, and immunization.


RESULTS
From October 20, 2000 to June 30, 2003, we enrolled 2366 patients. One thousand and eleven subjects (43%) reported substance abuse and 1095 (46%) were smokers. Of the 158 smokers contacted in follow-up, 19 (12%) had quit, 63 (40%) had reduced the number of cigarettes/day and 76 (48%) reported no change. Of 1248 women surveyed, 307 (25%) were overdue for a Pap smear and 54 (18%) received this intervention. Forty-four percent of subjects were overdue for at least one immunization and of those, 414 (40%) were immunized in the ED.


CONCLUSIONS
At-risk patients can be identified using a computer-based screening tool, and appropriate interventions can be given to a proportion of these patients in a busy inner city ED without increasing wait time.
Cummings
Garnet Edward
GE
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB. gcumming@ualberta.ca
Francescutti
Louis Hugo
LH
Predy
Gerald
G
Cummings
Greta
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002170:Canada / Q000453:epidemiology; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006306:Health Surveys; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D065006:Papanicolaou Test; D011322:Primary Prevention / Q000379:methods*; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation; D000074606:Smoking Prevention; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000517:prevention & control; D019037:Urban Health Services; D014505:Urban Population; D014626:Vaginal Smears / Q000706:statistics & numerical data