title: A comparison of interventions to improve clinic follow-up compliance after a pediatric emergency department visit.
abstract: A randomized prospective study was made to compare two interventions to improve compliance with follow-up appointments (FA) after a pediatric emergency department (ED) visit. The study population was 253 patients and families seen during daytime hours at a large pediatric ED and who required follow-up for their diagnosed condition. A control group of patients were told to call the clinic for FA, an appointment group of patients were given a FA in the ED prior to discharge and written reminder, and an intense group of patients were given a FA in the ED prior to discharge, a written reminder; they were offered a work excuse, child care, and transportation assistance; they were sent mailed reminders and had attempts at telephone reminders. More patients in the appointment group (47%, P < 0.001) and intense group (52%, P < 0.001) kept FA than the control group (24%). Attempted telephone contact was unsuccessful in 39% of the intense group. When telephone contact was successful, patients were more likely to keep FA (62 vs 38%, P < 0.04). Families left to make their own FA did so only 32% of the time. Medical record review of ED and clinic visits for one year after intervention indicated no long-term behavior change in appointment-making behavior or ED use in any group. It was concluded that providing a convenient FA prior to ED discharge improves compliance with clinic follow-up. If telephone contact is successful, telephone reminders also improve compliance. If follow-up is recommended, the majority of patients do not make their own appointments. A one-time intervention does not result in a long-term behavioral change in use of clinics or the ED.
authors.affiliation: Arkansas Children's Hospital, Department of Pediatrics, Little Rock, AR 72202, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: Komoroski
authors.forename: C J
authors.initials: CJ
authors.lastname: Graham
authors.forename: R S
authors.initials: RS
authors.lastname: Kirby
mesh_terms: D001071:Appointments and Schedules; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D007348:Insurance, Health; D008297:Male; D010033:Otitis Media / Q000628:therapy; D010349:Patient Compliance; D011446:Prospective Studies; D017010:Reminder Systems; D011795:Surveys and Questionnaires