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September 1996

Noncompliance With Scheduled Revisits to a Pediatric Emergency Department

Author Affiliations

From the Section of Pediatric Emergency Medicine, Department of Pediatrics, Temple University School of Medicine, and the Section of Emergency Medicine, Medical College of Pennsylvania, St Christopher's Hospital for Children, Philadelphia, Pa.

Arch Pediatr Adolesc Med. 1996;150(9):948-953. doi:10.1001/archpedi.1996.02170340062012

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