Patient Noncompliance With Medical Advice After the Emergency Department Visit

Thomas, Eric J.; Burstin, Helen; O’Neil, Anne; Orav, E. John; Brennan, Troyen A.

doi:10.1016/s0196-0644(96)70296-2

Cited by 155 publications

(97 citation statements)

References 12 publications

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“…For example, having a PCP appeared to increase ED patients' outpatient follow-up compliance and having Medicaid insurance appeared to decrease outpatient follow-up compliance, but neither of these findings was statistically significant. Prior studies have suggested that insurance status does not affect outpatient follow-up compliance, 7 and that having PCP is a stronger predictor for access to care among patients presenting to EDs. 10 Last, our study did not evaluate the effect that individual physicians have on outpatient follow-up compliance.…”

Section: Discussionmentioning

confidence: 99%

“…2 Notwithstanding these reasons, compliance with recommended follow-up by ED patients in the United States is frequently very poor and has been estimated to be between 26% and 56% depending on the ED population. [3][4][5][6][7] Prior studies have found that providing ED patients with outpatient appointments before their discharge significantly improves follow-up compliance. 6,7 These studies, however, were limited by their observational design and potential for confounding.…”

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confidence: 99%

“…[3][4][5][6][7] Prior studies have found that providing ED patients with outpatient appointments before their discharge significantly improves follow-up compliance. 6,7 These studies, however, were limited by their observational design and potential for confounding. To more definitively assess the effect of making follow-up appointments for patients in a general adult ED population, we conducted a randomized trial to compare follow-up compliance for ED patients with 2 different discharge instructional methods.…”

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confidence: 99%

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Brief report: Factors affecting outpatient follow-up compliance of emergency department patients

et al. 2005

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Background: Emergency department (ED) patients often fail to follow‐up with referrals to outpatient clinics and physicians. Objective: To compare the effects of 2 ED discharge instructional methods on outpatient follow‐up compliance and to evaluate sociodemographic characteristics as possible factors affecting outpatient follow‐up compliance. Design and Participants: Randomized trial of ED patients. At discharge, the intervention group had their follow‐up appointment made and the standard group was given our hospital's referral service phone number to make their own follow‐up appointment. Measurements: Outpatient clinics were called 1 month after each subject's ED discharge to ascertain if they followed‐up. Poisson regression was used to examine the effects of sociodemographic factors on follow‐up compliance. RESULTS: Of 287 eligible subjects, 250 (87%) agreed to participate. Follow‐up rates were 59% for the intervention group and 37% for the standard group (P<.001). Having a primary care physicians appeared to increase ED patients' outpatient follow‐up compliance and having Medicaid insurance appeared to decrease outpatient follow‐up compliance, but neither of these findings was statistically significant. Conclusions: In our ED, patients who have their outpatient follow‐up appointment made at discharge have a significantly greater probability of follow‐up compliance compared with patients given standard discharge instructions. Most sociodemographic characteristics do not affect our ED patients' follow‐up compliance.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Brief report: Factors affecting outpatient follow-up compliance of emergency department patients

et al. 2005

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“…This study was conducted at five urban teaching hospital EDs in the same metropolitan area. [15][16][17][18][19][20][21][22][23][24] Four of the study sites were Level 1 trauma centers, and these EDs had an annual census ranging from 27,000 to 66,000 at the time of the survey. All EDs were staffed by resident physicians with attending physician supervision.…”

Section: Methodsmentioning

confidence: 99%

Predictors and Outcomes of Frequent Emergency Department Users

2003

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Objective: To identify predictors and outcomes associated with frequent emergency department (ED) users. Methods: Cross-sectional intake surveys, medical chart reviews, and telephone follow-up interviews of patients presenting with selected chief complaints were performed at five urban EDs during a one-month study period in 1995. Frequent use was defined by four or more self-reported, prior ED visits. Multivariate logistic regression identified predictors of frequent ED visitors from five domains (demographics, health status, health access, health care preference, and severity of acute illness). Associations between high use and selected outcomes were assessed with logistic regression models. Results: All study components were completed by 2,333 of 3,455 eligible patients (67.5%). Demographics predicting frequent use included being a single parent, single or divorced marital status, high school education or less, and income of less than $10,000 (1995). Health status predictors included hospitalization in the preceding three months, high ratings of psychological distress, and asthma. Health access predictors included identifying an ED or a hospital clinic as the primary care site, having a primary care physician (PCP), and visiting a PCP in the past month. Choosing the ED for free care was the only health preference predictive of heavy use. Illness severity measures were higher in frequent visitors, although these were not independently predictive in the multivariate model. Outcomes correlated with heavy use include increased hospital admissions, higher rates of ED return visits, and lower patient satisfaction, but not willingness to return to the ED or follow-up with a doctor. Conclusions: Frequent ED visits are associated with socioeconomic distress, chronic illness, and high use of other health resources. Efforts to reduce ED visits require addressing the unique needs of these patients in the emergency and primary care settings.

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“…19 A study that evaluated five urban teaching hospital emergency departments evaluated the correlates of compliance with followup appointments and prescription filling after an emergency department visit. 28 Of the 1,386 patients interviewed, only 45% (408 patients) recalled being advised to take a medication and 12% (50) reported that they did not obtain the medications. In a 1997 study by Ordonez et al, children aged 3 to 15 years admitted to an Australian hospital with an acute asthma attack were evaluated to identify factors that might prevent future hospital …”

Section: ¨¨Discussionmentioning

confidence: 99%