This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Richard J. Scarfone, MD; Mark D. Joffe, MD; James F. Wiley II, MD; John M. Loiselle, MD; Richard T. Cook, MD

Arch Pediatr Adolesc Med. 1996;150(9):948-953.

Abstract
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.

Arch Pediatr Adolesc Med. 1996;150:948-953

Author Affiliations
From the Section of Pediatric Emergency Medicine, Department of Pediatrics, Temple University School of Medicine, and the Section of Emergency Medicine, Medical College of Pennsylvania, St Christopher's Hospital for Children, Philadelphia, Pa.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Brief Approaches to Educating Patients and Parents in Primary Care
Glascoe et al.
Pediatrics 1998;101 :e10-e10.
ABSTRACT | FULL TEXT