Predictors of patient adherence to follow-up recommendations after an ED visit

• Published in: The American journal of emergency medicine Vol. 33; no. 10; pp. 1368 - 1373
• Main Authors: Broadwater-Hollifield, Camille, PhD, MPH, Madsen, Troy E., MD, Porucznik, Christina A., PhD, MSPH, Sundwall, David N., MD, Youngquist, Scott T., MD, MSc, Vlasic, Kajsa, BA, Gren, Lisa H., PhD, MSPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2015; Elsevier Limited
• Subjects: Adult; Behavior; Confidence Intervals; Costs and Cost Analysis; Cross-Sectional Studies; Emergency; Emergency medical care; Emergency medical services; Emergency Service, Hospital - economics; Emergency Service, Hospital - statistics & numerical data; Emergency services; Ethnic Groups - statistics & numerical data; Female; Forecasting - methods; Health care policy; Health education; Hispanic people; Hospitals, Urban; Humans; Insurance, Health - economics; Insurance, Health - statistics & numerical data; Male; Observational studies; Patient Compliance - statistics & numerical data; Patients; Physicians, Primary Care - economics; Physicians, Primary Care - statistics & numerical data; Prospective Studies; Regression Analysis; Self Report; Social Class; Studies; Training Support - economics; Training Support - statistics & numerical data; Utah; Utah
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2015.07.032

Abstract Background It is unclear whether factors identified during the emergency department (ED) visit predict noncompliance with ED recommendations. Study objective We sought to determine predictors of adherence to medical recommendations after an ED visit. Methods We conducted a prospective, observational study at a single urban medical center. Eligible ED patients provided baseline demographic data as well as information regarding insurance status, whether they had a primary care physician (PCP), and the impact of cost of care on their ability to follow medical recommendations. Patients were contacted at least 1 week after the ED visit and answered questions regarding adherence to medical recommendations. Results Four hundred twenty-two patients agreed to participate in the study. At follow-up, 89.7% of patients reported that they had complied with recommendations made during the ED visit. Patients who were adherent to follow-up recommendations were more likely to have a primary care provider (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.1-6.1), have an annual income of greater than $35 000 (OR, 2.9; 95% CI, 1.2-7.2), and report a non-Hispanic ethnicity or race (OR, 2.8; 95% CI, 1.1-7.1). Individuals who reported that cost “sometimes” or “always” impacts their ability to follow their physician's recommendations were significantly less likely to comply with ED recommendations (OR, 2.7; 95% CI, 1.3-5.6). Conclusion Individuals who reported that cost affects their ability to follow their physician's recommendations and those who did not have a PCP were less likely to follow ED recommendations. Identification of predictors of noncompliance during the ED visit may aid in ensuring compliance with ED recommendations.