Objectives. Understand the vital role that HEDs play in syphilis elimination.Develop a strategy for engaging HEDs in syphilis elimination.Implement a plan for incorporating HEDs into strategic plans for eliminating syphilis.. What will we do today?. Learn about Guilford County's project with emerg
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
1. Partnering with hospital emergency departments Caroline Moseley, M.Ed.
Mark Schulz, Ph.D.
Manjunath Mahadevappa, MBBS, MPH
2. Objectives Understand the vital role that HEDs play in syphilis elimination.
Develop a strategy for engaging HEDs in syphilis elimination.
Implement a plan for incorporating HEDs into strategic plans for eliminating syphilis.
3. What will we do today? Learn about Guilford County’s project with emergency departments
Collaborations, history of the issue, status and results of current project
Work in groups to uncover our strengths and challenges
Develop action plans including a plan for accountability
4. Collaboration University of North Carolina Greensboro,
Guilford County Department of Public Health,
Moses Cone Hospital &
High Point Community Hospital
5. University of North Carolina Greensboro School of Health & Human Performance
Department of Public Health Education
MPH & BS
Epidemiologist & MPH student
Internal Review Board (IRB)
6. Data entry Many hours
Graduate assistant time donated
Followed conventions established @ 1st hospital
7. Data analysis SPSS
Analysis questions discussed & developed early w/C. Moseley
One way frequencies
Cross tabulations & more complicated analyses
Opportunities for further analysis
8. Literature review Focused on syphilis & emergency departments.
Syphilis & jails
Guidance from C. Moseley
9. Internal Review Board (IRB) Necessary for publication
C. Moseley provided links to hospitals
10. Guilford County Department of Public Health Had idea & initiated project
Collected data from 1st hospital
Connections to hospitals
Knew of STD reporting system
Funded MPH student for final semester
11. Hospitals Key contacts
Made data easily available
Open to changing policy
Open to in-service training
Facilitated IRB approval
12. Why partner with emergency departments Similar high risk populations
EDs are primary care centers
EDs have easy access to people at high risk for STDs
Screening programs are fairly easy to implement
Screening programs can be done for little money
13. Some background on Guilford County North Central North Carolina
Population 388,062 (1998)
Two major cities, Greensboro and High Point
Consistently high rates of STDs, including HIV
14. Trends in early syphilis, 1991-2003
15. Early syphilis 2003 Primary, secondary, and late latent syphilis is decreasing
The increase in syphilis between 2002 and 2003 is due to an increase in early latent cases
16. Some background on hospitals in Guilford County Two non-profit hospital systems that include four hospitals, three of which have emergency departments
Two private hospitals
Many people receive care outside of the county, especially for HIV
17. Background on relationship with emergency departments No previous direct collaborative relationship
Health director knew the ED heads through the medical societies
Health director had a personal connection with the head of Cone’s ED
18. Syphilis and emergency departments in Guilford County In 1996, 14.7% of all P & S syphilis cases were being diagnosed in an emergency department
Reports from emergency departments have steadily declined
This may be changing because of our study
19. Syphilis and emergency departments in Guilford County In the last quarter of 2003, 30% of all early syphilis cases were being diagnosed in an emergency department
Of all the cases reported by emergency departments, 67% of the cases were early latent
20. What was the process? Health director made a phone call
Staff met with the medical director
Medical director agreed to have screening practices assessed
Staff obtained permission from medical records
Staff conducted a records review
21. Assessment methods SPSS was used for data entry and analysis (2 separate databases)
406 records were randomly selected and reviewed
203 STD related (by ICD-9 Code)
203 records pulled from the same time frame
22. Assessment methods: Demographic variables Race
23. Assessment methods: Behavioral variables Pregnancy status
Primary ICD-9 code
RPR results (including titer)
Results of gonorrhea and chlamydia tests
Follow-up care for syphilis
Co-factors for syphilis (cocaine use, history of substance abuse)
24. Assessment results 94% of the general sample had ICD-9 codes that were not life threatening emergencies (one person in the STD sample)
The demographic characteristics of both samples are almost identical to those of people at risk for syphilis
25. Assessment results Very few people in both samples received syphilis tests
1% general got a test, 7% STD
Many more men than women in both samples were screened
100% general were men, 14% STD
26. Assessment results The majority who got screened in both samples were Black
100% general were black, 79% STD
No pregnant women in either sample were screened
No one in either sample who was positive for cocaine received and RPR
27. Assessment results Those who tested positive for gonorrhea/chlamydia in both samples were no more likely to receive and RPR than those who tested negative
Those in the STD sample had similar demographic and behavioral characteristics to those in the general sample but were no more likely to receive an RPR
28. Next steps Cross-sectional study in the two major emergency departments to test a screening protocol
29. Screening protocol Screen all pregnant women who don’t have prenatal care
Screen all people who get a gonorrhea and chlamydia test
Screen anyone who has a positive cocaine test or reports a history of drug use or prostitution
Treat all symptomatic patients
30. Study objectives Evaluate effectiveness of screening for syphilis in high risk patients visiting the Emergency departments (EDs).
Compare demographics of high risk patients in ED with syphilis cases in Guilford County, North Carolina.
31. Study design Cross-sectional study conducted over a period of six months in emergency departments of two big hospitals of Guilford County located in two different cities.
Over 2200 records of patients attending the EDs who are considered high risk for syphilis were reviewed.
32. Study design Continued
33. Methods SPSS was used to enter data obtained from reviewing the records.
Over 1200 records were reviewed in High Point Regional.
Over 1000 records were reviewed in Moses Cone
Over 38 variables were used to record the data.
34. Variables used Demographic variables
Other important variables
Primary care provider
Screening results of gonorrhea, chlamydia and syphilis.
Drug screen result
37. Comparison by age
38. Comparison by zip codes (Greensboro)
39. Comparison by zip codes (High Point)
40. Syphilis and other STDs
41. Patients with primary care physicians
42. Shifts seen in EDs
43. Cocaine positives among population screened at EDs
44. RPR positives among cocaine positives
45. Cocaine users among RPR positives
46. Lessons learned Make screening decision an ED policy
Bundle STD tests
Write standing orders for labs to screen cocaine positives for syphilis
University, county, EDs
Cocaine positives need to be screened
47. Things we will be doing in the future Analyze cost effectiveness of screening high risk patients.
Implement a research protocol for screening cocaine positives.