Noncompliance with scheduled revisits to a pediatric emergency department.
OBJECTIVE
To determine the incidence of, the risk factors associated with, and the consequences of noncompliance (NC) with a scheduled revisit to a pediatric emergency department (ED).


METHODS
A prospective, inceptive cohort study.


METHODS
An urban pediatric ED.


METHODS
A sample of 179 children.


METHODS
Interviews of parents and physicians.


RESULTS
Overall, 91 (51%) of the parents were noncompliant, and just 21% were noncompliant because "the child was better." Of the 124 patients who ED physicians believed were "certain to return," 57 (46%) were noncompliant. Six factors were associated with NC: (1) the parent believed that the child was not severely ill (relative risk [RR], 2.92; 95% confidence interval [CI], 1.31-6.49); (2) the parent was judged to be unable to recognize a clinical deterioration of the child (RR, 1.95; 95% CI, 1.55-2.45); (3) the parent did not own a car (RR, 1.77; 95% CI, 1.23-2.54); (4) the parent was younger than 21 years (RR, 1.48; 95% CI, 1.12-1.95); (5) no laboratory testing was performed during the initial ED visit (RR, 1.36; 95% CI, 1.03-1.80); and (6) the parent was judged "not certain" to return (RR, 1.34; 95% CI, 1.01-1.78).


CONCLUSIONS
The high rate and the lack of predictability of NC with a scheduled revisit to an ED should influence patient disposition decisions. The factors associated with NC in this study may serve as a model for identifying parents who are at a high risk of NC and as a foundation for interventions designed to improve compliance.
Scarfone
R J
RJ
Department of Pediatrics, Temple University School of Medicine, Philadelphia, Pa, USA.
Joffe
M D
MD
Wiley
J F
JF
Loiselle
J M
JM
Cook
R T
RT
D001071:Appointments and Schedules; D001294:Attitude to Health; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006302:Health Services Research; D006776:Hospitals, Pediatric; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D009042:Motivation; D010290:Parents / Q000523:psychology*; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016312:Treatment Refusal