scholarly journals HIV Testing and Referral to Care in U.S. Hospitals Prior to 2006: Results from a National Survey

2009 ◽  
Vol 124 (3) ◽  
pp. 400-408 ◽  
Author(s):  
Gretchen Williams Torres ◽  
Juliet Yonek ◽  
Jeremy Pickreign ◽  
Heidi Whitmore ◽  
Romana Hasnain-Wynia
Keyword(s):  
Hiv Testing ◽  
Clinical Symptoms ◽  
Geographic Location ◽  
Routine Screening ◽  
Behavioral Risk ◽  
Hospital Inpatient ◽  
Current Recommendation ◽  
Public Health Action ◽  
Hospital Size ◽  
Teaching Status

Objectives. We sought to provide a benchmark for human immunodeficiency virus (HIV) testing availability and practices in U.S. hospitals prior to the Centers for Disease Control and Prevention's (CDC's) 2006 revised recommendations. Methods. We conducted a survey of nonfederal general hospitals in the U.S. in 2004. Chi-square tests detected significant associations with hospital characteristics. Questionnaires were completed electronically via a secure Internet site or on paper. Nonresponse analysis was conducted and data were weighted to adjust for nonresponse. Results. HIV testing (on the basis of clinical symptoms or behavioral risk factors) was available in more than half of hospital inpatient units (62%), employee health departments (58%), and emergency departments (57%). Twenty-three percent offered routine screening (testing for people in a defined population regardless of clinical symptoms or behavioral risk), most commonly in labor and delivery. Teaching status, region, size, and type of metropolitan area were associated with the availability of HIV testing and routine screening ( p<0.01). Hospitals used a variety of methods to link patients to care: referral to a hospital-based clinic (36%); on-site, same-day evaluation (35%); and referral to an unaffiliated HIV or community clinic (42%). Conclusions. Hospitals offered HIV testing on the basis of clinical suspicion or risk, but were far from meeting CDC's current recommendation to routinely test all patients aged 13 to 64. Hospital size, teaching status, and geographic location were associated with HIV testing availability and testing practices. Our understanding of current practice identifies opportunities for public health action at the practitioner, organization, and systems levels.

Hospital efficiency and patient satisfaction

2003 ◽  
Vol 16 (1) ◽  
pp. 24-38 ◽  
Author(s):  
G. H. Pink ◽  
M. A. Murray ◽  
I. McKillop
Keyword(s):  
Patient Satisfaction ◽  
Religious Affiliation ◽  
Cost Model ◽  
Hospital Efficiency ◽  
Small Hospital ◽  
Hospital Size ◽  
Patient Dissatisfaction ◽  
Teaching Status ◽  
Underlying Causes ◽  
Using Data

The objective of this study was to investigate the relationship between efficiency and patient satisfaction for a sample of general, acute care hospitals in Ontario, Canada. A measure of patient satisfaction at the hospital level was constructed using data from a province-wide survey of patients in mid-1999. A measure of efficiency was constructed using data from a cost model used by the Ontario Ministry of Health, the primary funder of hospitals in Ontario. In accordance with previous studies, the model also included measures of hospital size, teaching status and rural location. Based on the results of this study, at a 95% confidence level, there does appear to be evidence to suggest that an inverse relationship between hospital efficiency and patient satisfaction exists. However, the magnitude of the effect appears to be small. Hospital size and teaching status also appear to affect satisfaction, with lower satisfaction scores reported among non-teaching and larger hospitals. This study did not find any evidence to suggest that hospital location (rural versus urban) or religious affiliation contributed to reports of patient satisfaction in any way not explained by the other measures included in the study. The findings imply that low patient satisfaction cannot be explained by excessive management concentration on efficiency. Managers should analyse some of the underlying causes of patient dissatisfaction before reconfiguring resources. It may be beneficial in larger hospitals to study the aspects of care that patients have reported they prefer in small hospitals.

scholarly journals State Trends in HIV Testing Among US Adults Aged 18-64 Years, 2011-2017

2020 ◽  
Vol 135 (4) ◽  
pp. 501-510
Author(s):  
Amy Krueger ◽  
Christopher Johnson ◽  
Janet Heitgerd ◽  
Deesha Patel ◽  
Norma Harris
Keyword(s):  
Hiv Testing ◽  
Adult Population ◽  
District Of Columbia ◽  
State Level ◽  
Behavioral Risk ◽  
Behavioral Risk Factor Surveillance ◽  
Persons Living With Hiv ◽  
System Data ◽  
The Mean ◽  
Low Prevalence

Objectives HIV testing identifies persons living with HIV and can lead to treatment, decreased risk behaviors, and reduced transmission. The objective of our study was to describe state-level trends in HIV testing in the general US adult population aged 18-64 years, for both ever tested for HIV and tested for HIV in the previous 12 months. Methods Using 2011-2017 Behavioral Risk Factor Surveillance System data, we estimated the percentage of the state population, plus the District of Columbia, aged 18-64 years ever tested for HIV and tested for HIV in the previous 12 months. The 50 states and the District of Columbia were grouped according to the estimated prevalence of HIV in 2011. We used orthogonal contrasts to calculate P values for linear trends. Results The percentage of the population ever tested for HIV increased significantly in 23 states during 2011-2017, whereas the percentage tested for HIV in the previous 12 months increased significantly in 8 states. In 2017, the mean percentage ever tested for HIV in states with a high prevalence of HIV was 8.6 percentage points higher than the mean percentage in states with a low prevalence of HIV (48.5% vs 39.9%); the mean increase in the percentage ever tested was highest (11.4%) in states with a low prevalence of HIV. Conclusion Enhanced efforts by states to make HIV testing simple, accessible, and routine are needed to reduce the number of persons who are not aware of their infection.

scholarly journals HIV testing in patients presenting with indicator conditions in outpatient settings: offer and uptake rates, and educational and active interventions

2018 ◽  
Vol 29 (13) ◽  
pp. 1289-1294
Author(s):  
Elaney Youssef ◽  
Tanjinder Sanghera ◽  
Andrew Bexley ◽  
Madeleine Hayes ◽  
Nicky Perry ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Individual Case ◽  
Case Note ◽  
Routine Screening ◽  
People Living With Hiv ◽  
Hiv Test ◽  
Uptake Rates ◽  
Undiagnosed Hiv ◽  
The Uk ◽  
Outpatient Settings

Approximately 13% of people living with HIV in the UK are undiagnosed which has significant implications in terms of onward transmission and late diagnosis. HIV testing guidelines recommend routine screening in anyone presenting to healthcare with an HIV indicator condition (IC); however, this does not occur routinely. This study aimed to assess the feasibility and effectiveness of using case note prompts highlighting the presence of an IC to increase HIV testing. Clinicians in three outpatient departments received case note prompts either before or after a period of clinician-led identification. Test offer and uptake rates were assessed. A parallel anonymous seroprevalence study estimated the prevalence of undiagnosed HIV. A total of 4191 patients had an appointment during the study period; 608 (14.5%) had an IC. HIV test offer was significantly higher when a prompt was inserted into notes (34.3% versus 3.2%, p < 0.001). The prevalence of diagnosed HIV in the cohort was 4.1%. No cases of undiagnosed HIV infection were identified. Despite guidelines, offer of HIV testing is low. Strategies to increase routine screening of patients presenting with an IC are needed. Individual case note prompts significantly increase HIV test offer; however, the effect is lost if the strategy is withdrawn.

Designated Stroke Center Status and Hospital Characteristics as Predictors of In-Hospital Mortality among Hemorrhagic Stroke Patients in New York, 2008-2012

2016 ◽  
Vol 43 (1-2) ◽  
pp. 43-53 ◽  
Author(s):  
Hajere J. Gatollari ◽  
Anna Colello ◽  
Bonnie Eisenberg ◽  
Ian Brissette ◽  
Jorge Luna ◽  
...  
Keyword(s):  
New York ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Hemorrhagic Stroke ◽  
New York State ◽  
Hospital Level ◽  
Stroke Patients ◽  
Hospital Size ◽  
Teaching Status ◽  
Hospital Characteristics

Background: Although designated stroke centers (DSCs) improve the quality of care and clinical outcomes for ischemic stroke patients, less is known about the benefits of DSCs for patients with intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). Hypothesis: Compared to non-DSCs, hospitals with the DSC status have lower in-hospital mortality rates for hemorrhagic stroke patients. We believed these effects would sustain over a period of time after adjusting for hospital-level characteristics, including hospital size, urban location, and teaching status. Methods and Results: We evaluated ICH (International Classification of Diseases, Ninth Revision; ICD-9: 431) and SAH (ICD-9: 430) hospitalizations documented in the 2008-2012 New York State Department of Health Statewide Planning and Research Cooperative System inpatient sample database. Generalized estimating equation logistic regression was used to evaluate the association between DSC status and in-hospital mortality. We calculated ORs and 95% CIs adjusted for clustering of patients within facilities, other hospital characteristics, and individual level characteristics. Planned secondary analyses explored other hospital characteristics associated with in-hospital mortality. In 6,352 ICH and 3,369 SAH patients in the study sample, in-hospital mortality was higher among those with ICH compared to SAH (23.7 vs. 18.5%). Unadjusted analyses revealed that DSC status was related with reduced mortality for both ICH (OR 0.7, 95% CI 0.5-0.8) and SAH patients (OR 0.4, 95% CI 0.3-0.7). DSC remained a significant predictor of lower in-hospital mortality for SAH patients (OR 0.6, 95% CI 0.3-0.9) but not for ICH patients (OR 0.8, 95% CI 0.6-1.0) after adjusting for patient demographic characteristics, comorbidities, hospital size, teaching status and location. Conclusions: Admission to a DSC was independently associated with reduced in-hospital mortality for SAH patients but not for those with ICH. Other patient and hospital characteristics may explain the benefits of DSC status on outcomes after ICH. For conditions with clear treatments such as ischemic stroke and SAH, being treated in a DSC improves outcomes, but this trend was not observed in those with strokes, in those who did not have clear treatment guidelines. Identifying hospital-level factors associated with ICH and SAH represents a means to identify and improve gaps in stroke systems of care.

Routine or targeted HIV screening of Indonesian prisoners

2016 ◽  
Vol 12 (1) ◽  
pp. 17-26 ◽  
Author(s):  
Erni Juwita Nelwan ◽  
Ahmad Isa ◽  
Bachti Alisjahbana ◽  
Nurlita Triani ◽  
Iqbal Djamaris ◽  
...  
Keyword(s):  
Drug Use ◽  
Hiv Testing ◽  
Hiv Infections ◽  
Hiv Treatment ◽  
Routine Screening ◽  
Hiv Positive ◽  
Hiv Screening ◽  
Content Type ◽  
Targeted Screening ◽  
Routine Hiv Screening

Purpose – Routine HIV screening of prisoners is generally recommended, but rarely implemented in low-resource settings. Targeted screening can be used as an alternative. Both strategies may provide an opportunity to start HIV treatment but no formal comparisons have been done of these two strategies. The paper aims to discuss these issues. Design/methodology/approach – The authors compared yield and costs of routine and targeted screening in a narcotic prison in Indonesia. Routine HIV screening was done for all incoming prisoners from August 2007-February 2009, after it was switched for budgetary reasons to targeted (“opt-out”) HIV screening of inmates classified as people who inject drugs (PWIDs), and “opt-in” HIV testing for all non-PWIDs. Findings – During routine screening 662 inmates were included. All 115 PWIDs and 93.2 percent of non-PWIDs agreed to be tested, 37.4 percent and 0.4 percent respectively were HIV-positive. During targeted screening (March 2009-October 2010), of 888 inmates who entered prison, 107 reported injecting drug use and were offered HIV testing, of whom 31 (29 percent) chose not to be tested and 25.0 percent of those tested were HIV-positive. Of 781 non-PWIDs, 187 (24 percent) came for testing (opt-in), and 2.1 percent were infected. During targeted screening fewer people admitted drug use (12.0 vs 17.4 percent). Routine screening yielded twice as many HIV-infected subjects (45 vs 23). The estimated cost per detected HIV infection was 338 USD for routine and 263 USD for targeted screening. Originality/value – In a resource limited setting like Indonesia, routine HIV screening in prison is feasible and more effective than targeted screening, which may be stigmatizing. HIV infections that remain unrecognized can fuel ongoing transmission in prison and lead to unnecessary disease progression and deaths.

scholarly journals ED Visits Related to Marijuana Exposures in the Denver Metropolitan Area of Colorado

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Yushiuan Chen ◽  
Michele Askenazi ◽  
Kathryn H. DeYoung ◽  
Bernadette Albanese ◽  
Lourdes W. Yun ◽  
...  
Keyword(s):  
Surveillance System ◽  
Geographic Location ◽  
Marijuana Use ◽  
Behavioral Risk ◽  
Behavioral Risk Factor ◽  
Geographic Disparities ◽  
Behavioral Risk Factor Surveillance ◽  
Risk Factor Surveillance ◽  
Usage Patterns ◽  
Ed Visits

To explore whether disparities exist among persons seeking emergency department (ED) care related to marijuana use, we developed marijuana case (MJCs) definitions, provided an overview of the prevalence of ED visits related to marijuana use, and identified differences in MJCs by age, gender, and geographic location. Males and persons aged 18-44 years constituted a higher proportion of MJCs, which may be related to differences in usage patterns as identified by the BehaviOral Risk Factor Surveillance System. Denver and Arapahoe Counties had a higher percentage of pediatric MJCs. More advanced spatial analysis will describe details of geographic disparities in the research.

scholarly journals HIV Testing: Support for Routine Screening

1970 ◽  
Vol 10 (1) ◽  
Author(s):  
Brett Edwards, BSc. Pharm ◽  
Stephen Vaughan MD DTMH
Keyword(s):  
Hiv Testing ◽  
Task Force ◽  
Preventive Services ◽  
The United States ◽  
Routine Screening ◽  
Hiv Screening ◽  
Screening Cost ◽  
National Body ◽  
Routine Hiv Screening ◽  
Routine Hiv Testing

This article discusses the recent evolution of human immunodeficiency virus (HIV) screening recommendations with significantly expanded role for routine HIV testing. After the Centre for Disease Control (CDC) released recommendations for routine screening in 2006, it was anticipated that the United States Preventive Services Task Force (USPSTF), a national body charged with providing evidence-based recommendations for preventive services, would follow shortly. However, they refrained, citing a lack of evidence at the time to make such a recommendation, and maintained a recommendation for risk-based screening. Following an analysis of recent literature, in 2013 the USPSTF finally made a recommendation for routine HIV screening on the grounds of new evidence. The recommendations are based on the clinical benefit, the failures of risk-based screening, cost-effectiveness data with reduction in HIV related morbidity/mortality, and lower rates of transmission. This article highlights some of the literature that accounted for the change in recommendations and provides a basic review of HIV testing techniques available to the internists and the recommendations for routine screening of patients.

scholarly journals Impact of a structured medical staff education program on the effect of HIV testing in four multi-specialist hospitals of the mazowieckie voivodeship as a part of the „Stop late presenters” – project

2020 ◽  
pp. 133-146
Keyword(s):  
Hiv Infection ◽  
Hiv Testing ◽  
Hiv Transmission ◽  
Clinical Symptoms ◽  
Medical Personnel ◽  
Late Presenters ◽  
Disease Mortality ◽  
Hospital Wards ◽  
Positive Results

In half of newly detected cases of HIV infection in Europe, the diagnosis is made late. This has significant impact on the effects of antiretroviral therapy, long-term consequences of the disease, mortality, and the risk of HIV transmission in the environment. As part of the large “STOP Late Presenters” project, the number of HIV tests was assessed in four multi-specialist hospitals in the Mazowieckie voivodeship, which generally carry out over 112,000 hospitalizations per year. First, under the structured research program, the training of medical personnel was carried out in these hospitals, and then the number of HIV tests ordered was evaluated 2 months and 4 months after the training. 459 HIV tests were performed after the training in all hospitals, which is 2.44% of hospitalizations. It is interesting to note that after 4 months, the number of performed tests fell significantly. Staff training resulted in the number of tests higher by 5.8 %, compared to the same period of previous year. Four positive results were confirmed, which is 0.87% of all tests done. This is almost twice higher than in other European countries. Tests for HIV infection are most often ordered by doctors of infectious diseases, gynecologists and the staff of dialysis departments. We found that there is little interest in HIV testing among other specialists, despite reporting patients with clinical symptoms that suggest the likelihood of this infection. The improvement in HIV testing is of great importance for public health in our country and requires modification of diagnostic algorithms in hospital wards to reduce the number of late diagnoses of HIV / AIDS.

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