Factors associated with failure to follow up with a general practitioner after discharge from the emergency department

Abstract

Objectives: To identify factors associated with failure to follow up with a general practitioner (GP) after discharge from the ED or emergency medicine unit (EMU).

Methods: This prospective cohort study enrolled adult patients discharged from the ED who were requested to see their GP to complete their medical care. Participants were contacted by phone after 2 weeks to determine GP follow-up status. Variables associated with failure to follow up were determined using multivariate logistic regression.

Results: Of 247 participants enrolled, 217 had complete outcome data. After controlling for the confounding effect of other variables, four variables remained significantly associated with follow-up status. Compared with participants who did follow up, those who failed to follow up were less likely to have an EMU admission (OR 0.46, 95% CI 0.22-0.93, P < 0.03), a regular GP (OR 0.16, 95% CI 0.08-0.35, P < 0.001), health insurance (OR 0.41, 95% CI 0.20-0.82, P < 0.01) or awareness of the reason why they were supposed to follow up (OR 0.25, 95% CI 0.11-0.54, P < 0.001). The most common reason for failure to follow up (65%) was that the participant did not consider it necessary.

Conclusion: Participants who were aware of the reason for follow up with a GP, who were admitted to EMU, had health insurance or had a regular GP were more likely to comply with follow-up advice. This highlights that good patient communication is important for successful follow up, and that alternative avenues for completion of management need to be explored for patients without health insurance or a regular GP.