Outpatient Follow-up For Emergency Department Patients In Prince George's County, Maryland

Background: Uninsured and low-income patients often rely on “safety net” clinics and emergency departments (ED) for their medical care. The Prince George's county healthcare safety net has limited capacity to serve its 80,000 adult uninsured residents. Objectives: This study investigates the impact of ED direct scheduling on the ability of patients to establish primary care within the physician's recommended time frame. In addition, the study describes patients' self-reported barriers to accessing primary care upon discharge from the ED. Methods: A randomized prospective pilot study of ED adult patients was conducted. A direct scheduler was placed in the ED to coordinate discharge follow up for intervention patients. English speaking patients without a primary care physician who required follow up with a PCP within a 3-week time frame were invited to participate. At discharge, the intervention group had a follow-up appointment made with either of two participating low-cost clinics and the control group was given the routine discharge contact information and instructions to schedule a follow-up appointment. All participants were called one month after their ED visit to ascertain if they followed-up and to discuss barriers to follow-up. Clinics were also called to verify appointment attendance. A proportional t-test was used for comparison of data. Results: The study enrolled 66 patients. Demographic characteristics and disease severity were similar between the intervention and control groups. Follow-up rates were 29% for the intervention group and 40% for the control group (P=0.25). There was no difference in follow up between the two clinics in the intervention group. The most common reason for not following up for both groups was a lack of transportation (13%), resolution of symptoms (13%), and work conflict (13%). Patients with chronic medical complaints were more likely (30% vs. 9%, p=0.03) to follow up with an outpatient clinic. Conclusion: Providing a scheduled appointment upon discharge from the ED did not improve compliance with outpatient follow up. However, patients with chronic medical complaints were more likely to obtain outpatient follow up. Subsidized transportation options and flexibility of appointment hours may contribute to higher compliance with outpatient follow-up among this at risk population.