Abstract
Urban adolescents with pelvic inflammatory disease (PID) often seek care in emergency departments (ED). This study examines the effect of the ED patient experience - wait time (WT) and length of stay (LOS) - on satisfaction and medication adherence among urban adolescents with PID. Adolescents with PID were enrolled in an urban teaching hospital ED. Chart data were matched with 2-week interview queries about satisfaction and medication adherence. Chi-square and logistic regression analyses evaluated the relationships between WT, LOS, provider type, satisfaction, and medication adherence. Of 83 participants, 96% report satisfaction with care, but only 45% report medication adherence. Mean WT was 55 minutes and mean LOS 200 minutes. Patients with higher LOS were less adherent with medication; this relationship became non-significant after adjustments. Patients seen by trainees had much longer LOS, but no differences in satisfaction or medication adherence. Urban adolescents with PID report satisfaction with ED care despite prolonged LOS and medication adherence is poor. Optimization of ED workflows may improve outcomes in young women with PID.
Highlights
Pelvic inflammatory disease (PID) is a common and serious upper reproductive tract disorder that disproportionately affects young and minority women
The disease is caused by sexually transmitted infections (STIs) including Chlamydia trachomatis (CT) and/or Neisseria gonorrhoeae (GC), and each episode increases the risk of long-term sequelae, the public health impacts for optimal treatment and patient adherence are significant [4]
During the period of 08/06/2012 – 12/7/2016, 127 women diagnosed with PID were enrolled in the control arm of the Technology Enhanced Community Health Nursing (TECH-N) study. 83 patients were treated in the emergency department (ED) setting and completed the two-week questionnaire. (Figure 1) The majority of patients (71%) were enrolled in the Pediatric ED, while the remainder was enrolled in the Adult ED
Summary
Pelvic inflammatory disease (PID) is a common and serious upper reproductive tract disorder that disproportionately affects young and minority women. The disease is caused by sexually transmitted infections (STIs) including Chlamydia trachomatis (CT) and/or Neisseria gonorrhoeae (GC), and each episode increases the risk of long-term sequelae, the public health impacts for optimal treatment and patient adherence are significant [4]. Minority adolescents and young adults often assume great responsibility for health care decision-making and self-management and the ED provides an immediate response to a perceived health threat or when patients have difficulty accessing other systems of care [5]. Several studies have demonstrated poor adherence to the CDC guidance on treatment of PID by ED providers, which may influence both patient satisfaction and longitudinal reproductive health outcomes [6,7]
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