Abstract
Problem/Purpose: Findings from a number of studies suggest that minority populations are less likely to adhere to follow-up in ambulatory settings. However, there is a paucity of literature on adherence to discharge instructions including follow-up from emergency departments as it relates to race as well as race specific barriers to adherence. The purpose of the study was to compare compliance rates and barriers to ED discharge instructions between Caucasian, Black, and Hispanic patients. Theory/ Hypothesis: No hypothesis or theory is stated.Methods: The study employed a prospective design whereby subjects discharged from a university suburban tertiary healthcare facility were followed over a 6-month period.
Sample: The subjects included in the study were aged 17 years or more and had been discharged from the ED with specific instructions to attend a follow-up visit with a physician within a time period of 2 weeks. Institutionalized, mentally impaired, and subjects evaluated by a psychiatrist were excluded from the study. Measures: Participants did a telephone survey within four weeks of discharge from the ED. The survey items assessed compliance with follow-up as well as to the filling of any drug orders given at discharge. Procedures/Statistical tests: Emergency department charts were reviewed on 3 preselected days every week for 6 months and participants who met the inclusion criteria identified. Subjects were contacted 2 weeks post-discharge. The STATA software was used to compute the X2 (P<.05) used to compare the compliance rates to ED discharge instructions and barriers faced by whites, blacks, and Hispanics. Multiple logistic regression was used to predict compliance and the impact of socio-demographic variables.Results: 268 Caucasian, 64 Hispanic, and 141 black eligible individuals were contacted. Of these, 133 (53.1%) Caucasian, 49 (76.6%) Hispanics, and 69 (48.9%) blacks consented to the study. Adherence to follow-up and prescription filling amongst the Caucasian, black, and Hispanic participants was 62.4% and 83.7%, 56.5% and 86.7%, and 53.1% and 94.5% respectively (nonsignificant c2 test). The white subjects mostly reported feeling better as the reason for nonadherence (30%). The black (49%) and Hispanic (34%) subjects, on the other hand, mostly reported problems scheduling a follow-up appointment as the prime reason for non-compliance.
Significance: Follow-up costs were not reported as a major barrier to follow up in spite of disparities in the number of uninsured persons in the various groups. This implies that efforts to improve ED post-discharge follow up rates for a diverse population also need to focus on institutional barriers to follow up in addition to enhancing access to care.
Conclusion: The differences in overall adherence between the three groups were not statistically significant. Compared to white patients, Hispanic and black patients reported more difficulty in scheduling a follow-up appointment within the time period of 2 weeks of post-discharge from the ED.
Limitations: The methodology used prevented the inclusion of participants who could not be reached via phone. Implications for practice: This is the first study that has investigated the racial impact of barriers to follow-up to ED discharge instructions. It provides preliminary findings on the issue that warrant further exploration in other studies.Brief critique of article: The title of the article is short and concise. It details in one statement the focus matter of the study. The introduction section establishes the background and need of the study. The methods section describes in an in depth manner the procedures followed. The findings of the study are well presented in the results section using descriptive statistics and figures. The discussion section describes the results of the study in light of existing literature. The limitations of the study are clearly stated. The conclusion section succinctly summarizes the contents of the article.
References
James, T. D., Smith, P. C., & Brice, P. H. (2010). Self-reported discharge instruction adherence among different racial groups seen in the emergency department. Journal of the National Medical Association, 102 (10), 931-936.
