Self-reported discharge instruction adherence among different racial groups seen in the emergency department.
OBJECTIVE
To compare emergency department (ED) discharge instructions adherence rates and barriers faced by white, black, and Hispanic patients.


METHODS
A 6-month prospective follow-up study was conducted in a suburban tertiary care facility. Subjects were adult (>17 years) ED patients discharged with a specific instruction to follow-up with a physician within 2 weeks. Excluded subjects were mentally impaired, evaluated by psychiatry, or institutionalized. Subjects completed a telephone interview within 4 weeks to determine adherence to follow-up and the filling of any prescription given them.


RESULTS
Of 268 white, 141 black, and 64 Hispanic eligible persons, 133 (53.1%) white, 69 (48.9%) black, and 49 (76.6%) Hispanic subjects participated. Adherence for follow-up and prescription, respectively, was 62.4% and 83.7% in whites, 56.5% and 86.7% in blacks, and 53.1% and 94.5% in Hispanics (nonsignificant chi2 test). White subjects were more likely to report feeling better as a reason for noncompliance (30%), while black (49%) and Hispanic (34%) subjects were more likely to have difficulty getting a follow-up appointment.


CONCLUSIONS
Black and Hispanic patients were more likely than white patients to report difficulty in getting a follow-up appointment within a 2-week period, even though overall adherence was statistically similar between groups. Despite varied level of uninsured patients within each racial group, perceived follow-up cost was not found to be a major barrier. This suggests that improving adherence for a diverse population will require addressing institutional barriers such as appointment wait times and physician-patient ratios in addition to current efforts to increase access to care.
Department of Emergency Medicine, CB# 7594, University of North Carolina, Chapel Hill, NC 27599-7594, USA.
Tiencia D
TD
James
Patrick Carlsen
PC
Smith
Jane H
JH
Brice
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010349:Patient Compliance / Q000208:ethnology*; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D044465:White People / Q000706:statistics & numerical data