title: Enhancing referral of sexually active adolescent females from the emergency department to family planning.
abstract: BACKGROUND
  Female adolescents at high pregnancy risk frequently visit the emergency department (ED) and lack primary providers. It is unclear if current methods of ED referral are successful. The objective of this pilot study was to assess the potential effect and feasibility of a standardized, enhanced method of referral of sexually active females from an ED for family planning (FP).
  
  
  METHODS
  We conducted an ED-based intervention study using an enhanced referral process, which included a wallet card advertising a walk-in, adolescent-friendly FP clinic and a standardized ED physician monologue. ED physicians were instructed to disseminate the enhanced process to sexually active females ages 12-19 years (intervention group). Patients receiving the intervention were prospectively enrolled. The control group consisted of patients who, on retrospective review, came to the ED during the enrollment period and were eligible but were not enrolled. We used the electronic medical record (EMR) to identify and randomly select missed eligible patients (control group) and accumulated one control for each case. The primary outcome was FP follow-up within 2 months, measured by EMR review.
  
  
  RESULTS
  The intervention (n=101) and control groups (n=101) were similar in age, prior ED visits (54% versus 56%), and previous FP visits (28% versus 28%). The absolute difference in follow-up to a FP clinic between the enhanced referral group (7%; 7/101) compared with the nonenhanced referral group (5%; 5/101) was only 2% (95% confidence interval -5% to 9%). Feasibility of the intervention was modest, with a best-case scenario of 59/160 (37%) of eligible patients captured.
  
  
  CONCLUSIONS
  An enhanced referral initiative relying on physician participation did not substantially increase follow-up rates to a FP clinic and showed modest feasibility. More research is required to identify effective means of ED-based referral for preventive reproductive care.
authors: 1 Department of Pediatrics, Columbia University Medical Center , New York, New York.
authors: Lauren S
authors: LS
authors: Chernick
authors: Carolyn
authors: C
authors: Westhoff
authors: Margaret
authors: M
authors: Ray
authors: Madelyn
authors: M
authors: Garcia
authors: Janet
authors: J
authors: Garth
authors: John
authors: J
authors: Santelli
authors: Peter S
authors: PS
authors: Dayan
mesh_terms: D000293:Adolescent; D002648:Child; D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital; D005193:Family Planning Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D009519:New York City; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D011247:Pregnancy; D011320:Primary Health Care; D011446:Prospective Studies; D012017:Referral and Consultation; D012189:Retrospective Studies; D055815:Young Adult