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Article |

Noncompliance With Scheduled Revisits to a Pediatric Emergency Department

Richard J. Scarfone, MD; Mark D. Joffe, MD; James F. Wiley II, MD; John M. Loiselle, MD; Richard T. Cook, MD
Arch Pediatr Adolesc Med. 1996;150(9):948-953. doi:10.1001/archpedi.1996.02170340062012.
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Objectives:  To determine the incidence of, the risk factors associated with, and the consequences of noncompliance (NC) with a scheduled revisit to a pediatric emergency department (ED).

Design:  A prospective, inceptive cohort study.

Setting:  An urban pediatric ED.

Patients:  A sample of 179 children.

Interventions:  Interviews of parents and physicians.

Results:  Overall, 91 (51%) of the parents were noncompliant, and just 21% were noncompliant because "the child was better." Of the 124 patients who ED physicians believed were "certain to return," 57 (46%) were noncompliant. Six factors were associated with NC: (1) the parent believed that the child was not severely ill (relative risk [RR], 2.92; 95% confidence interval [CI], 1.31-6.49); (2) the parent was judged to be unable to recognize a clinical deterioration of the child (RR, 1.95; 95% CI, 1.55-2.45); (3) the parent did not own a car (RR, 1.77; 95% CI, 1.23-2.54); (4) the parent was younger than 21 years (RR, 1.48; 95% CI, 1.12-1.95); (5) no laboratory testing was performed during the initial ED visit (RR, 1.36; 95% CI, 1.03-1.80); and (6) the parent was judged "not certain" to return (RR, 1.34; 95% CI, 1.01-1.78).

Conclusions:  The high rate and the lack of predictability of NC with a scheduled revisit to an ED should influence patient disposition decisions. The factors associated with NC in this study may serve as a model for identifying parents who are at a high risk of NC and as a foundation for interventions designed to improve compliance.Arch Pediatr Adolesc Med. 1996;150:948-953


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