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.