Patient noncompliance with medical advice after the emergency department visit

Abstract

Study objective: To determine the correlates of compliance with follow-up appointments and prescription filling after an emergency department visit.

Methods: This prospective cohort study was undertaken as part of the Emergency Department Quality Study evaluation of five urban teaching hospital EDs in the northeastern United States. Of 2,757 eligible patients who presented with abdominal pain, asthma, chest pain, hand lacerations, head trauma, or first-trimester vaginal bleeding and were enrolled during 1-month period, 2,315 (84%) completed on-site baseline questionnaires. Information about diagnoses, socioeconomic status, discharge instructions, insurance status, and primary care was obtained from the on-site patient surveys and from reviews of medical records. A 76% random sample of patients who completed the questionnaire was generated, and 1,386 patients (79% of the sample) were interviewed by telephone approximately 10 days after their ED visit to determine compliance with follow-up appointments and prescription filling.

Results: Of the 1,386 patients interviewed at 10 days, 914 (66%) had been discharged from the ED, and 408 (45%) of those discharged recalled being advised to take a medication. Fifty of these patients (12%) reported that they did not obtain the medication. Significant independent correlates of not filling prescriptions were lack of insurance (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.1 to 5.5) and dissatisfaction with discharge instructions (OR, 2.8; 95% CI, 1.2 to 6.4). Two hundred thirty-five (26%) of the discharged patients said they were given follow-up appointments and did not have an appointment pending at the time of the interview; 77 (33%) of these patients reported having missed their appointment. The only significant independent correlate of missing follow-up appointments was being given a telephone number to call instead of leaving the ED with an appointment scheduled (OR, 3.8; 95% CI, 1.7 to 8.8).

Conclusion: Not having an appointment made before leaving the ED was an independent correlate of missing follow-up appointments. Lack of insurance and dissatisfaction with discharge instructions were independent correlates of not filling prescriptions.