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More screening needed to detect injury, violence risk


 

FROM THE LANCET

Physicians need to do more to screen patients to find those at risk for preventable injuries and violence, according to the Centers for Disease Control and Prevention.

"Physicians and other health care workers have not yet included screening for injury risk into routine standard of care," representatives of the agency wrote in an article published July 2 in the online version of the Lancet (2014, July 2 [http://dx.doi.org/10.1016/S0140-6736(14)60074-x]).

The agency cited statistics that one in five adults visiting health care providers received counseling about injury prevention. The failure to provide such counseling is a function of time, according to the authors.

"This absence may be partly due to the increase in demands on practitioners – if primary care physicians were to satisfy fully the clinical recommendations of the U.S. Preventive Services Task Force, then they would need to devote longer than 7 hours per day to preventive services alone," according to Tamara M. Haegerich, Ph.D., associate director for science in the injury center in CDC’s Division of Unintentional Injury Prevention. "Managed care organizations and other health care institutions have not fully codified injury prevention counseling into clinical workflow and electronic medical records to improve the delivery of injury prevention services."

For 2010, the most frequent causes of deaths from unintentional injury included motor vehicle crashes (33,687 people), poisoning (33,041), falls (26,009), suffocation (6,165), drowning (3,782), and fire (2,845). Unintentional injury was the largest cause of potential life-years lost before age 65 years. Additionally, for nonfatal injuries, falling was the most common injury, leading to more than 9 million emergency department visits. The top three causes of death for people aged 1-30 years were unintentional injury, suicide, and homicide, which together accounted for close to 80% of deaths in this group. About 20% of deaths among the young were related to chronic diseases and only 1% was from infectious diseases.

One area in which physician counseling may be able to save lives is in prescription drug overdoses, according to the report. Overdose can occur through intentional or unintentional means, although most deaths from overdose are unintentional. In 2010, 38,329 people in the United States died from a drug overdose. Prescription drugs were involved in 22,134 of these deaths (nearly 60%). An overdose of opioid analgesics such as oxycodone, hydrocodone, and methadone accounted for 75% of prescription drug deaths. It is noteworthy that deaths from opioid analgesics have nearly quadrupled since 1990 and that four times more prescription painkillers were sold to pharmacies, hospitals, and doctors’ offices in 2010 than in 1999. Drug overdose is commonly viewed as an issue of substance misuse, mental health, or law enforcement rather than an injury and public health concern; however, this rise in overdose deaths coincides with an increase in the supply of prescription painkillers, indicating a need for intervention from health professionals.

Also in 2010, the 31.2 million unintentional and violence-related nonfatal injuries cost more than $513 billion in medical care and lost productivity, and this figure does not include costs associated with nonmedically treated injuries, legal costs, or indirect costs from other health problems associated with or exacerbated by violence and injuries.

The article notes that evidence-based interventions do exist to help prevent injuries and violence, "but too often they are not available, not affordable, or simply not used by patients, providers, and consumers. The gap between research and practice, or discovery and delivery, is large and continues to impede progress in the U.S.A."

However, opportunity now exists "to advance injury prevention through screening and referral for injury risk factors such as depression, domestic violence (for women of child-bearing age), alcohol misuse, and behavioral problems (for children)," according to Dr. Haegerich and her associates, who added that innovations in health information technology, such as clinical decision support tools embedded within electronic health records, "could enhance health providers’ ability to provide injury preventive services [such as triggering] alerts for screening on the basis of risk factors for patients, provide real-time information about evidence-based treatment guidelines, generate reports that share information about injury prevention with patients or automate referrals to community services."

Overall, the article calls for those in public health to work in partnership with clinical medicine "to ensure that health delivery systems are well integrated and are performing effectively, efficiently and equitably to prevent injury and improve outcomes throughout the continuum of care."

gtwachtman@frontlinemedcom.com

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