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  • Printed Materials Provided at ED Discharge Boost Follow-Up Rates

    By Lynda Seminara
    Selected by Richard K. Parrish II, MD
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    Journal Highlights

    American Journal of Ophthalmology, January 2023

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    Studies have shown wide-ranging rates of compliance to follow-up care after emergency department (ED) visits, and it is difficult to predict which patients won’t comply. Furthermore, data on follow-up after ophthalmic-related ED visits are lacking. Dong et al. looked at factors that may discourage follow-up care and tested an intervention aimed at improving compliance. Their proto­col, which included written materials, led to significantly better compliance rates.

    This prospective study included an intervention group and historical controls. Follow-up care was defined as presentation to the ophthalmology clinic of Jamaica Hospital (New York City) within six weeks of an ED visit at the same hospital.

    Patients in the intervention group (n = 199) received verbal instructions, written instructions, and follow-up telephone calls. If they did not take ac­tion, a letter was mailed to their home. Those in the control group (n = 763) received verbal instructions only. The main outcome measure was the differ­ence in overall follow-up rates between the study cohorts. Other outcomes were follow-up rates for demographic subsets. The authors developed a di­agnostic classification system for their study, with risk of adverse outcomes ranked from lowest (class I) to highest (class V).

    Results of the data analysis showed that follow-up was significantly more common in the intervention group (68.8% vs. 42.9% in the control group; p < .001). Significant improvement also occurred in most demograph­ic subgroups. Exceptions included young adults (18-29 years of age), patients with diagnosis severity class III, patients without insurance, those with hospital financial aid, and patients with unknown employment status. The strongest predictors of obtaining fol­low-up were having health insurance, having class IV disease severity, and receiving the intervention.

    Of note, control participants with class V severity also were unlikely to pursue follow-up care. This was surprising, the authors noted, as these patients have the greatest risk for loss of vision and loss of life.

    Moreover, there are sight- and life-threatening conditions that have only mild symptoms, further emphasizing the importance of timely follow-up. It may be possible to boost follow-up rates for the least-compliant patients by targeting and tailoring efforts to them, said the authors.

    The original article can be found here.