Randomized controlled trial to improve primary care follow-up among emergency department patients

Rory J Merritt; Paige Kulie; Andrew W Long; Tina Choudhri; Melissa L McCarthy

doi:10.1016/j.ajem.2019.158384

Randomized controlled trial to improve primary care follow-up among emergency department patients

Am J Emerg Med. 2020 Jun;38(6):1115-1122. doi: 10.1016/j.ajem.2019.158384. Epub 2019 Aug 2.

Authors

Rory J Merritt¹, Paige Kulie², Andrew W Long², Tina Choudhri³, Melissa L McCarthy⁴

Affiliations

¹ Department of Emergency Medicine, Brown University, 55 Claverick Street, Providence, RI 02903, United States of America. Electronic address: Rory_Merritt@Brown.edu.
² Department of Emergency Medicine, George Washington University, Washington, DC, United States of America.
³ University of Michigan, Ann Arbor, MI, United States of America.
⁴ Department of Health Policy and Management, Department of Emergency Medicine, George Washington University, Washington, DC, United States of America.

PMID: 31402234
DOI: 10.1016/j.ajem.2019.158384

Abstract

Study objective: Primary care (PC) follow-up for discharged emergency department (ED) patients provides patients with further medical attention. We conducted a pilot randomized controlled trial to determine whether using a freely-available physician appointment-booking website results in higher self-reported PC follow-up.

Methods: We randomized discharged patients whom treating physicians determined PC follow-up was important and who possessed health insurance but had no PC provider to one of three groups: (1) a PC appointment booked through the booking website prior to ED discharge; (2) written information on how to use the booking website; or (3) usual care (i.e. standard follow-up instructions). We phoned subjects two weeks after the ED visit to determine whether they had completed a PC follow-up visit. We also asked subjects about their satisfaction with obtaining a PC appointment, satisfaction with the ED visit, symptom resolution and subsequent ED visits. The self-reported PCP follow-up rate was compared among the study groups by estimating the risk difference (RD) and 95% CI between usual care and each intervention group.

Results: 272 subjects were enrolled and randomized and 68% completed the two-week telephone follow-up interview. The self-reported PCP follow-up rate was higher (52%) among subjects whose appointment was booked on the website before ED discharge (RD = 16%; 95% CI -1%, 34%) and lower (25%) for subjects who received booking website information (RD = 13%; 95% CI -32%, 7%) compared to subjects (36%) in the usual care group. A higher percentage of subjects in the booking group were more likely to report being extremely or very satisfied with obtaining a PC appointment (78%) compared to those who received booking website information (54%) or usual care (40%).

Conclusion: Among ED patients that providers judged PC follow-up is important, using a booking website to schedule an appointment before ED discharge resulted in a higher but not statistically significant self-reported PC follow-up rate. This intervention warrants further investigation in a study with a larger sample size and objective follow-up visit data.

Keywords: Emergency department; Primary care.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aftercare
Appointments and Schedules*
Continuity of Patient Care / standards*
Emergencies*
Emergency Service, Hospital / standards*
Female
Follow-Up Studies
Humans
Male
Patient Compliance*
Patient Discharge / trends
Patient Satisfaction*
Pilot Projects
Primary Health Care / standards*
Quality Improvement*
Young Adult