title: Factors associated with physician follow-up among patients with chest pain discharged from the emergency department.
abstract: BACKGROUND
  Many patients with chest pain do not receive follow-up from a physician after discharge from the emergency department despite significant survival benefit associated with follow-up care. Our objective was to evaluate factors associated with physician follow-up to understand this gap in practice.
  
  
  METHODS
  We conducted an observational study involving patients at high risk who were assessed for chest pain and discharged from an emergency department in Ontario between April 2004 and March 2010. We used multivariable logistic regression to determine the association of clinical and nonclinical characteristics with physician follow-up.
  
  
  RESULTS
  We identified 56 767 patients, of whom 25.1% did not receive any follow-up by a physician, 69.0% were seen by their primary care physician, and 17.3% were seen by a cardiologist within 30 days. Patients who had medical comorbidities and cardiac conditions such as myocardial infarction or heart failure were less likely to have follow-up. In contrast, a previous visit to a primary care physician was associated with the highest odds of having physician follow-up (odds ratio [OR] 6.44, 95% confidence interval [CI] 5.91-7.01). Similarly, a previous visit to a cardiologist was strongly associated with follow-up by a cardiologist (OR 3.01, 95% CI 2.85-3.17). Patients evaluated in emergency departments with the highest tertile of chest pain volume were more likely to receive follow-up from any physician (OR 1.52, 95% CI 1.31-1.77) and from a cardiologist (OR 2.04, 95% CI 1.61-2.57).
  
  
  CONCLUSIONS
  Nonclinical factors are strongly associated with physician follow-up for patients with chest pain after discharge from the emergency department. However, patients with comorbidities and at higher risk for future adverse events are less likely to receive follow-up care.
authors.affiliation: From the Institute of Clinical Evaluative Sciences, (Wong, Wang, Koh, Tu, Schull, Wijeysundera, Ko); the Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto (Wong, Czarnecki, Tu, Schull, Wijeysundera, Lau, Ko), Toronto, Ont.
authors.forename: Michael K Y
authors.initials: MK
authors.lastname: Wong
authors.affiliation: From the Institute of Clinical Evaluative Sciences, (Wong, Wang, Koh, Tu, Schull, Wijeysundera, Ko); the Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto (Wong, Czarnecki, Tu, Schull, Wijeysundera, Lau, Ko), Toronto, Ont.
authors.forename: Julie T
authors.initials: JT
authors.lastname: Wang
authors.affiliation: From the Institute of Clinical Evaluative Sciences, (Wong, Wang, Koh, Tu, Schull, Wijeysundera, Ko); the Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto (Wong, Czarnecki, Tu, Schull, Wijeysundera, Lau, Ko), Toronto, Ont.
authors.forename: Andrew
authors.initials: A
authors.lastname: Czarnecki
authors.affiliation: From the Institute of Clinical Evaluative Sciences, (Wong, Wang, Koh, Tu, Schull, Wijeysundera, Ko); the Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto (Wong, Czarnecki, Tu, Schull, Wijeysundera, Lau, Ko), Toronto, Ont.
authors.forename: Maria
authors.initials: M
authors.lastname: Koh
authors.affiliation: From the Institute of Clinical Evaluative Sciences, (Wong, Wang, Koh, Tu, Schull, Wijeysundera, Ko); the Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto (Wong, Czarnecki, Tu, Schull, Wijeysundera, Lau, Ko), Toronto, Ont.
authors.forename: Jack V
authors.initials: JV
authors.lastname: Tu
authors.affiliation: From the Institute of Clinical Evaluative Sciences, (Wong, Wang, Koh, Tu, Schull, Wijeysundera, Ko); the Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto (Wong, Czarnecki, Tu, Schull, Wijeysundera, Lau, Ko), Toronto, Ont.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Schull
authors.affiliation: From the Institute of Clinical Evaluative Sciences, (Wong, Wang, Koh, Tu, Schull, Wijeysundera, Ko); the Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto (Wong, Czarnecki, Tu, Schull, Wijeysundera, Lau, Ko), Toronto, Ont.
authors.forename: Harindra C
authors.initials: HC
authors.lastname: Wijeysundera
authors.affiliation: From the Institute of Clinical Evaluative Sciences, (Wong, Wang, Koh, Tu, Schull, Wijeysundera, Ko); the Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto (Wong, Czarnecki, Tu, Schull, Wijeysundera, Lau, Ko), Toronto, Ont.
authors.forename: Ching
authors.initials: C
authors.lastname: Lau
authors.affiliation: From the Institute of Clinical Evaluative Sciences, (Wong, Wang, Koh, Tu, Schull, Wijeysundera, Ko); the Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto (Wong, Czarnecki, Tu, Schull, Wijeysundera, Lau, Ko), Toronto, Ont. dennis.ko@ices.on.ca.
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Ko
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002309:Cardiology; D002637:Chest Pain / Q000209:etiology / Q000628:therapy*; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D003625:Data Collection; D016208:Databases, Factual; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010351:Patient Discharge; D012307:Risk Factors; D055815:Young Adult