Measuring the quality of medical care for women who experience sexual assault with data from the National Hospital Ambulatory Medical Care Survey

Study Objective: We provide new descriptive epidemiology on the demography and quality of care of women who experience sexual assault. Two limited aspects of emergency department treatment received by women who have experienced sexual assault are examined: (1) administration of emergency contraception to prevent pregnancy and (2) screening and treatment for sexually transmitted diseases (STDs). Methods: A nationally representative survey on the basis of 7 years of data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) was analyzed. Estimates of mean numbers of patients treated and characteristics of patients are reported for administration of emergency contraception and compliance with STD guidelines. Results: Analysis shows that the number of rapes per year reported in the NHAMCS data is highly consistent with the number of forcible rapes reported by the Federal Bureau of Investigation. Result show statistically significant differences in patients who receive screening on the basis of age and also suggest that the same differenced exist for STD medications received. Accounting for differences in screening and medications by age does not completely explain why a large portion of the patients are neither screened nor receive STD medications. Conclusion: Women are not receiving the full complement of treatment, as suggested by the Centers for Disease Control and Prevention guidelines. Administration of emergency contraception is less frequent in the NHAMCS sample than in hospitals with sexual assault treatment program that report administration of emergency contraception. It is important to assess care for patients experiencing sexual assault in a nationally representative sample to identify defiencies in treatment and areas in need of improvement.
Author: 
Amey,Annette L.
Bishai,David
Reprint Status: 
IN FILE
Start Page: 
631
End Page: 
638
Journal/Periodical Name: 
Annals of Emergency Medicine
Volume: 
39
Issue: 
6
Abstract: 
According to CDC guidelines, victims of rape should be offered emergency contraception (EC) as well as screening and treatment for sexually transmitted diseases (STDs). The extent to which these treatments have been provided has not been assessed at a national level. This study offers a descriptive epidemiology of female rape victims receiving these particular services at emergency departments (ED) by drawing upon a nationally representative sample. These findings were then compared with CDC guidelines. Data was collected from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for the years spanning 1992 to 1998. Cases were deemed as receiving EC if women were administered or prescribed drugs from the national drug class 1040 (contraceptives). Women were considered to have obtained screening for STDs if they received urinalysis tests or specific CPT procedures. Furthermore, women were considered to have received treatment if they were given prophylaxis. Findings revealed 204 sexual assault cases from a total of 182,107 ED records available. Results indicated that 20% of women received EC, 36% were screened for STDs, and 23% were screened for HIV. Of those screened, only 34% received STD treatment. Women over 18 were twice as likely to receive STD screening and treatment than those younger than 18 years. Black women were significantly more likely to be screened for STDs and more likely to receive prophylaxis than White women were. The authors conclude that a significant number of victims of sexual assault are not receiving ED medical care as recommended by CDC guidelines and may be better served by hospitals with specialized programs for sexual trauma.
Topic Areas: 
Effects; medical response; racial/ethnic differences
Reference Type: 
JOUR
Reference ID: 
1962
Publication Date: 
2002/June