Noncompliance with scheduled revisits to a pediatric emergency department
R. J. Scarfone, M. D. Joffe, J. F. Wiley 2nd, J. M. Loiselle and R. T. Cook
Department of Pediatrics, Temple University School of Medicine, Philadelphia, Pa, USA.
OBJECTIVES: To determine the incidence of, the risk factors associated
with, and the consequences of noncompliance (NC) with a scheduled revisit
to a pediatric emergency department (ED). DESIGN: A prospective, inceptive
cohort study. SETTING: An urban pediatric ED. PATIENTS: A sample of 179
children. INTERVENTIONS: Interviews of parents and physicians. RESULTS:
Overall, 91 (51%) of the parents were noncompliant, and just 21% were
noncompliant because "the child was better." Of the 124 patients who ED
physicians believed were "certain to return," 57 (46%) were noncompliant.
Six factors were associated with NC: (1) the parent believed that the child
was not severely ill (relative risk [RR], 2.92; 95% confidence interval
[CI], 1.31-6.49); (2) the parent was judged to be unable to recognize a
clinical deterioration of the child (RR, 1.95; 95% CI, 1.55-2.45); (3) the
parent did not own a car (RR, 1.77; 95% CI, 1.23-2.54); (4) the parent was
younger than 21 years (RR, 1.48; 95% CI, 1.12-1.95); (5) no laboratory
testing was performed during the initial ED visit (RR, 1.36; 95% CI,
1.03-1.80); and (6) the parent was judged "not certain" to return (RR,
1.34; 95% CI, 1.01-1.78). CONCLUSIONS: The high rate and the lack of
predictability of NC with a scheduled revisit to an ED should influence
patient disposition decisions. The factors associated with NC in this study
may serve as a model for identifying parents who are at a high risk of NC
and as a foundation for interventions designed to improve compliance.
