Mismatch Between Emergency Physician Follow-Up Recommendations and Primary Care Visit Attendance Among Older Adults: A Retrospective Cohort Study.

Abstract

Little is known about the referral timeframes emergency department (ED) providers recommend following emergency care and the frequency with which patients attend primary care provider (PCP) appointments within these specific timeframes. In this retrospective cohort study of adults aged 65 and older discharged home from nine EDs in Michigan, we evaluated patient attendance at PCP appointments within the timeframe recommended by the ED provider. We used descriptive statistics and multivariable regression (logistic and Cox proportional hazards) to identify factors associated with follow-up visit attendance and time to attendance. Among 1030 older adults, 81.9% of patients were recommended to follow up with a PCP. Of these patients, 39.9% and 13.7% were recommended follow-up within 1-3 days or 4-7 days, respectively. The overall rate of attendance at PCP visits within the recommended timeframe was 26.8% (95% CI 23.8-29.9). Only 15.2% (95% CI 12.3-18.5) of patients who were recommended follow-up within 7 days attended in that timeframe. Patients with shorter-interval follow-up recommendations and those seen at a safety-net ED were less likely to attend follow-up in the recommended timeframe. More than half of older adults were recommended primary care follow-up within 7 days, yet few attended visits in the timeframe recommended by the ED provider. Further research is needed to define appropriate follow-up timing and solutions to close the gap between a high portion of early follow-up recommendations and low visit attendance shortly after ED discharge.