[Show abstract][Hide abstract]ABSTRACT: Multiple barriers to traditional pretest HIV counseling make HIV testing difficult to accomplish in the emergency department setting in off hours. This study compares the educational effectiveness of a 10-minute pretest counseling video with the usual practice of a session with an HIV counselor.
This was a prospective randomized controlled trial of adult patients presenting to the urgent care area of a busy inner-city hospital. Patients either viewed an HIV educational video or spoke with an HIV counselor for pretest counseling. The video was developed by 2 of the investigators (YC, MH) and covered essential educational elements for HIV testing, as required by the New York State Department of Health. All participants completed a measure of HIV knowledge after their intervention. An equivalence analysis was performed to assess whether the video was at least as good as counseling in terms of overall mean knowledge score.
Of 129 patients recruited for the study, 65 patients were randomized to the intervention and 64 patients to the control group. Five patients were unable to complete the study. The final analysis was based on 124 patients. Mean knowledge scores were higher in the intervention (85.3% versus 79.7%; 90% confidence interval for the difference 2.6% to 8.7%).
We conclude that the use of an educational video with an inner-city adult population was at least as effective as in-person pretest counseling in conveying information related to HIV testing.
[Show abstract][Hide abstract]ABSTRACT: The purpose of this study was to compare a brief screening tool with physicians' usual practice in detecting depressive symptoms in patients presenting with somatic complaints to an inner-city emergency department. Depression is a major cause of morbidity and mortality in the United States. Underprivileged patients who rely on emergency departments for primary care remain at risk for undetected depression.
This prospective observational study included all patients older than 18 years presenting to an urgent care clinic staffed by emergency physicians in an urban public hospital during an eight-week period. Clinically unstable patients and those with a chief complaint of depression were excluded. After consenting, patients completed a previously validated two-question screening tool for depression. Patients identified as having depressive symptoms were referred to social workers for evaluation for possible psychiatric intervention.
Of the 226 patients enrolled, 55% (124/226; 95% confidence interval [CI] = 48% to 61%) screened positive for depressive symptoms. Physicians identified 14% (31/226; 95% CI = 10% to 19%) as having depressive symptoms. The kappa value was 0.22 (95% CI = 0.14 to 0.29). All patients but one identified as positive by the physicians screened positive on the screening tool. Patients who screened positive were referred to social workers. The physicians failed to identify 19 of the patients who needed further psychiatric care.
Depressive symptoms are common among patients in urgent care settings with somatic complaints. A simple screening tool identified more patients for further evaluation than does physicians' usual practice.