What really happens when patients leave the emergency department? Self-reported discharge instruction adherence among different racial groups seen in the emergency department

Abstract

Study objectives: The purpose of this study is to compare adherence rates to discharge instructions and barriers faced between white, black, and Hispanic patients. Methods: A prospective observational study was conducted from February 1, 2003, to September 1, 2003, at a university-based Level I trauma center. A convenience sample was taken of black, Hispanic, and white adult patients who were discharged from the emergency d epartment with a recommended follow-up appointment within 2 weeks. Patients were excluded if they were not given a specific time for follow-up or if they were residents of an institution (jail, nursing home, psychiatric facility). Within 1 month of discharge, patients were contacted by telephone to complete a telephone survey. The main outcome measures were the rate of adherence to recommended follow-up and the specific barriers faced for patients unable to attend their appointments. Data were recorded in percentages, and statistical significance was analyzed using the χ2 test. Results: Of 268 white, 141 black, and 64 Hispanic eligible patients, 133 (53.1%) white, 69 (48.9%) black, and 49 (76.6%) Hispanic patients completed the telephone interview. Adherence to follow-up appointment was 62.41% for white, 56.52% for black, and 53.06% for Hispanic patients (P=.59). White patients were more likely to report “feeling better” (30%) as a barrier to follow-up, whereas black (49%) and Hispanic (34%) patients were more likely to “have difficulty in getting an appointment.” Conclusion: Black and Hispanic patients are more likely than whites to report difficulty in getting an appointment within a 2-week period for follow-up, even though the overall adherence is similar between groups. Despite the varied level of uninsured patients within each racial group, cost was not found to be a major barrier, which suggests that improving adherence for a diverse population will require addressing institutional barriers such as appointment wait time and physician-to-patient ratios, in addition to current efforts to increase access to care. Study objectives: The purpose of this study is to compare adherence rates to discharge instructions and barriers faced between white, black, and Hispanic patients. Methods: A prospective observational study was conducted from February 1, 2003, to September 1, 2003, at a university-based Level I trauma center. A convenience sample was taken of black, Hispanic, and white adult patients who were discharged from the emergency d epartment with a recommended follow-up appointment within 2 weeks. Patients were excluded if they were not given a specific time for follow-up or if they were residents of an institution (jail, nursing home, psychiatric facility). Within 1 month of discharge, patients were contacted by telephone to complete a telephone survey. The main outcome measures were the rate of adherence to recommended follow-up and the specific barriers faced for patients unable to attend their appointments. Data were recorded in percentages, and statistical significance was analyzed using the χ2 test. Results: Of 268 white, 141 black, and 64 Hispanic eligible patients, 133 (53.1%) white, 69 (48.9%) black, and 49 (76.6%) Hispanic patients completed the telephone interview. Adherence to follow-up appointment was 62.41% for white, 56.52% for black, and 53.06% for Hispanic patients (P=.59). White patients were more likely to report “feeling better” (30%) as a barrier to follow-up, whereas black (49%) and Hispanic (34%) patients were more likely to “have difficulty in getting an appointment.” Conclusion: Black and Hispanic patients are more likely than whites to report difficulty in getting an appointment within a 2-week period for follow-up, even though the overall adherence is similar between groups. Despite the varied level of uninsured patients within each racial group, cost was not found to be a major barrier, which suggests that improving adherence for a diverse population will require addressing institutional barriers such as appointment wait time and physician-to-patient ratios, in addition to current efforts to increase access to care.