Essay on Adherence to ED-Generated Follow-Up

Essay on Adherence to ED-Generated Follow-Up

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The aim of this study is to quantify ED-generated follow-up adherence rates amongst white, Black American, and Hispanic patients discharged from the ED of a managed care system.
Problem Statement
Previous studies have established that the adherence rates to ED-generated referrals are below par. These rates range between 26% and 56% amongst different ED populations (Kyriacou et al., 2005) even though higher (68 and 71.4%) and lower (17%) rates have been reported (Friedman, Dios, & Hannenman, 2010; Saroff, Dell, & Brown, 2001). The reasons for the poor compliance have also been identified. Amongst the commonly cited reasons is the problem of accessibility due to lack of primary care providers and insurance cover. Notably, majority of these studies have evaluated different aspects of nonadherence and the reasons thereof. The design and implementation of concrete solutions to the problem of noncompliance requires more specific information on what factors affect which ED population and to what extent. Some studies have tried to be more specific by attempting to eliminate certain barriers through pre-scheduling of patient appointments before discharge (Kyriacou et al., 2005) and utilization of a capitated managed care system (Saroff, Dell, & Brown, 2001). None of these studies has focused on eliminating the influence of multiple factors though and the only study that was conducted in a managed care set up is limited by its retrospective design.
Rationale for Conducting the Study
Adherence to ED-generated outpatient referrals is influenced by patient, provider, and health care system- related variables (Kyricou et al., 2005). Elimination of the impact of health care system-related access barriers will, through elimination of ...

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... Self-reported discharge instruction adherence among different racial groups seen in the emergency department. Journal of the National Medical Association, 102 (10), 931-936.
Kyriacou, D. N., Dan Handel, M. D., Stein, A. C., & Nelson, R. R. (2005). Brief report: Factors affecting outpatient follow-up compliance of emergency department patients. Journal of General Internal Medicine, 20(10), 938-942.
Saroff, D., Dell, R., & Brown, E. R. (2002). International Journal for Quality Health Care, 14(2), 149-153.
Zorc J. J., Chew, A., & Shaw, K. (2009). Beliefs and barriers to follow-up after an emergency department asthma visit: A randomized trial. Pediatrics, 124 (4), 1135-1142.
Han, C.Y., Barnard, A., & Chapman, H. (2009). Emergency department nurses' understanding and experiences of implementing discharge planning. Journal of Advanced Nursing, 65(6), 1283-1292.

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