- Healthcare professionals have long been looking to reduce long emergency department wait times and overcrowding, both of which are often the result of patients accessing ED care that could otherwise be addressed in the primary care practice, such as HIV screenings. Better patient care access is key for addressing that issue.
Researchers from the University of Arizona (UA) say they have developed a viable solution to that problem – keep typical primary care services such as HIV screening part of the ED. The key is to ensure these services are seamless.
The ED often sees an influx of patients who suspect they have been exposed to HIV and are in need of a screening. Although HIV and other sexually transmitted infections can be tested in primary care or urgent care settings, many patients with limited care access will look to the ED as a care option.
Led by Brad Dreifuss, MD, University of Arizona assistant professor of emergency medicine and public health, a team of infectious disease and public health experts developed a plan to more seamlessly integrate HIV screening into the ED. This will help medically underserved patients while also reducing ED overcrowding.
Dreifuss was joined by infectious disease experts Shannon Smith and Alyssa Guido in his project to expand HIV testing into the ED. The Arizona Department of Health Services (ADHS) commissioned UA to administer HIV screenings to all ED patients, offering funding to the Arizona AIDS Education & Training Center (AETC) to expand its efforts into EDs across the state.
The proposal to integrate HIV testing in the ED was met with some skepticism, according to Dreifuss. ED clinicians had concerns about the time burden involved in administering the HIV screening to each patient. Additionally, clinicians had concerns about coordinating follow-up care for patients.
"Typically, if we send for diagnostic testing in the emergency department, it's our responsibility to appropriately address the test results with the patient," Dreifuss said in a public statement. "We needed to ensure there was a safe and efficient way of doing so."
The team forged a partnership with the Peterson HIV Clinics, a local health site that helps patients following an HIV diagnosis. This partnership gave the team the leverage necessary to implement the HIV care access program.
Following program implementation in August 2013, the UA EDs were able to detect many patients who were HIV positive and in need of care intervention. Between 15 and 20 percent of diagnoses were acute, which means patients were sick and needed immediate care, according to Dreifuss.
Those successes help changed the minds of initially reluctant emergency department doctors, the team said. Currently, two Tucson Banner – University Medical Center facilities administer HIV testing on patients, yielding at test rate of between 100 and 140 patients monthly.
This helps the hospital coordinate care for patients who need help accessing specialty HIV care, said Smith, who is the director of special projects in Infectious Diseases at UA.
"We're able to follow up with the patients quickly, get them to the clinic quickly and get them access to lifesaving treatments quickly," Smith explained.
Patients with an HIV diagnosis rely on immediate access to anti-retroviral therapy and other treatments. Delaying access to the treatment allows the HIV to destroy the body’s immune system, making it more difficult to control the virus, Smith explained.
Letting patients access HIV screening in the hospital also helped UA administer certain medication protocol that could quell the virus contraction, the team reported. When a patient presents in the ED stating that he may have been exposed to HIV, clinicians can begin him on a drug regimen that will in many cases keep him from actually contracting HIV.
Prior to the ED program, clinicians at UA had to refer patients back to community health clinics with HIV treatment resources. When patients could not access that care, there was a chaotic scramble within UA to help the patient access treatment.
Partnerships between the ED, hospital social workers, and infectious disease experts has helped patients access these medications in a seamless manner. Patients accessing the medications to potentially stop HIV contraction are also referred to the Peterson HIV Clinic.
Going forward, the team is working on a streamlined process by which ED doctors can prescribe an initial five-day dosage of anti-retroviral medications to patients receiving a confirmed HIV diagnosis. This will help patients kick off their treatment process in an effective manner.
Access to healthcare is a significant issue many medical experts are currently facing. When a patient may have contracted a serious infectious disease such as HIV, it is critical that patients can detect and manage the disease as soon as possible.
Putting HIV screenings in accessible spaces such as EDs may make it easier for all patients, including those who are medically underserved, to obtain care.