Purchase this article with an account.
Evan Chen, Aneesha Ahluwalia, Kristen Harris Nwanyanwu; Factors Associated with Nonadherence to Emergency Department Referrals for Follow-up Ophthalmic Care. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3077.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Patient adherence to emergency department (ED) recommendations for follow-up care is critical to ensure treatment continuity and identify potential misdiagnoses or complications. This study examines whether baseline factors at the time of ED visit for an ophthalmic condition can predict nonadherence to recommendations for follow-up ophthalmology care.
We conducted a retrospective single-center cohort study. Eligible participants were those that visited the ED between January 2013 and June 2019 and received instructions to follow-up with an ophthalmologist. Patient demographic, and visit characteristics were collected from chart review and assessed for association with adherence to a follow-up appointment within 1-month of the ED visit by logistic regression. This study was approved by the Yale University Institutional Review Board.
Of 2,366 patients referred to follow-up ophthalmic care after an emergency department visit, 628 (26.9%) did not complete their follow-up within 1-month of ED discharge. The average time to follow-up was 4.5 days and 82% of patients followed-up within 1 week of the ED visit. Patients who were nonadherent to recommended follow-up instructions were more likely to be younger in age (OR, 0.998; 95% CI, 0.996-0.999, P=<0.001), have a longer duration of time between the ED visit and the scheduled follow-up appointment (OR, 1.02; 95% CI, 1.01-1.02, P<0.0001), and have Medicaid (OR, 1.09; 95% CI, 1.03-1.15, P=0.003) or no insurance (OR, 1.07; 95% CI, 1.00-1.14, P=0.044) compared to commercial insurances. All factors remained significant in multivariate regression. Having an ophthalmology consult during the ED visit was not significantly associated with adherence, nor was having a primary care physician, patient gender, primary language or race.
Younger patients who had Medicaid or no insurance and a longer duration between an ED visit and the follow-up ophthalmology appointment were less likely to complete recommended follow-up care. Determining factors associated with decreased patient adherence to follow-up appointments can help identify patients who may require additional counseling or reminders, which, in turn, can improve overall effectiveness of care initiated in the ED and prevent potential complications.
This is a 2020 ARVO Annual Meeting abstract.
This PDF is available to Subscribers Only