Factors associated with failure to follow up with a general practitioner after discharge from the emergency department

Authors


  • Rizwan Qureshi, MBBS, MRCS Ed, Registrar; Stephen E Asha, BSc, MBBS, FACEM, Emergency Physician, Lecturer (Conjoint); Mehr Zahra, MBBS, Resident Medical Officer; Samuel Howell, MBChB, BSc, Resident Medical Officer.

Correspondence: Dr Stephen E Asha, Emergency Department, St George Hospital, Gray Street, Kogarah, NSW 2217, Australia. Email: stephen.asha@sesiahs.health.nsw.gov.au

Abstract

Objectives

To identify factors associated with failure to follow up with a general practitioner (GP) after discharge from the ED or emergency medicine unit (EMU).

Methods

This prospective cohort study enrolled adult patients discharged from the ED who were requested to see their GP to complete their medical care. Participants were contacted by phone after 2 weeks to determine GP follow-up status. Variables associated with failure to follow up were determined using multivariate logistic regression.

Results

Of 247 participants enrolled, 217 had complete outcome data. After controlling for the confounding effect of other variables, four variables remained significantly associated with follow-up status. Compared with participants who did follow up, those who failed to follow up were less likely to have an EMU admission (OR 0.46, 95% CI 0.22–0.93, P < 0.03), a regular GP (OR 0.16, 95% CI 0.08–0.35, P < 0.001), health insurance (OR 0.41, 95% CI 0.20–0.82, P < 0.01) or awareness of the reason why they were supposed to follow up (OR 0.25, 95% CI 0.11–0.54, P < 0.001). The most common reason for failure to follow up (65%) was that the participant did not consider it necessary.

Conclusion

Participants who were aware of the reason for follow up with a GP, who were admitted to EMU, had health insurance or had a regular GP were more likely to comply with follow-up advice. This highlights that good patient communication is important for successful follow up, and that alternative avenues for completion of management need to be explored for patients without health insurance or a regular GP.

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