Millions of Americans who use the ED each year are subsequently referred for outpatient care and follow-up with other physicians or clinics and prescribed necessary medications following their ED visit. Adherence with recommendations from ED providers is critical to ensuring that proper treatment of the initial condition be continued upon discharge. Adherence is also critical for identifying potential misdiagnoses and managing possible treatment failures and complications.

Despite its importance and cost to the healthcare system, studies suggest that compliance with recommendations by ED patients in the United States is frequently poor. Research has provided little insight on factors that may help predict non-compliance with recommendations from ED physicians. “In the emergency setting, clinicians may benefit from developing a better understanding about why patients don’t always follow recommendations from their physicians,” says Camille Broadwater-Hollifield, PhD, MPH.


Taking a Closer Look

In a study published in the American Journal of Emergency Medicine, Dr. Broadwater-Hollifield and colleagues sought to determine predictors of adherence to medical recommendations after an ED visit. They conducted a prospective, observational study at an urban medical center that involved 422 ED patients. Participants provided baseline demographic data as well as information about their insurance status, whether or not they had a primary care physician (PCP), and the impact of costs of care on their ability to follow medical recommendations. Patients were contacted at least 1 week after their initial ED visit and answered questions about adherence to medical recommendations from ED personnel.

According to the results, nearly 90% of study participants self-reported that they had complied with at least one recommendation made during their ED visit. “Patients who were adherent to follow-up recommendations were more likely to have a PCP,” says Dr. Broadwater-Hollifield. These individuals were also more likely to have higher annual incomes and to report being of non-Hispanic ethnicity or race:

Characteristic Odds Ratio
Have a primary care provider 2.6
Have an annual income >$35,000 2.9
Report non-Hispanic ethnicity/race 2.8

“Importantly, we also found that participants who reported that cost ‘sometimes’ or ‘always’ impacted their ability to follow their physician’s recommendations were significantly less likely to comply with ED recommendations,” Dr. Broadwater-Hollifield says. “This highlights the need for physicians to think about costs when they’re caring for patients in the ED.”


Assessing the Implications

According to Dr. Broadwater-Hollifield, ED physicians should consider possible barriers to compliance when they care for their patients including access and cost. “Based on our findings, providers should ask if patients have a PCP” she says. “Assisting patients in connecting with PCPs is a high-yield strategy to increase adherence to recommendations. Additionally, it may be prudent to discuss lower cost alternatives to medications. Furthermore, hospitals should develop mechanisms that will ensure patients will receive follow-up care from PCPs in order to potentially improve outcomes, such as scheduling follow-up appointments in the ED.”