242604 Outpatient Follow-up For Emergency Department Patients In Prince George's County, Maryland

Tuesday, November 1, 2011

Malika Fair, MD, MPH , Department of Emergency Medicine, George Washington University, Washington, DC
Anna Dill, BS , Medical School, George Washington University, Washington, DC
Rachelle Pierre-Mathieu, MD, MPP , Department of Emergency Medicine, George Washington University, Washington, DC
Peter Shin, PhD , Department of Health Policy, George Washington University School of Public Health, Washington, DC
Janice Blanchard, MD, PhD , Department of Emergency Medicine, George Washington University, Washington, DC
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.

Learning Areas:
Provision of health care to the public
Public health or related research

Learning Objectives:
Discuss the impact of direct scheduling on the ability of emergency department patients to establish primary care within an appropriate time frame. Describe patient’s accounts of barriers to accessing primary care upon discharge from the emergency department within the uninsured population.

Keywords: Emergency Department/Room, Access to Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am currently an MD/MPH candidate that conducted research on the project that is named. I have worked as a program coordinator or conducted research in public health, environmental health, and community health for the last 6 years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.