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Use of Follow-up Services by Patients Referred from a Walk-in Unit: How Can Patient Compliance Be Improved?

Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Hospital, the Charles A. Dana Research Institute, and the Harvard-Thorndike Laboratory

Russell S. Phillips

Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Hospital, the Charles A. Dana Research Institute, and the Harvard-Thorndike Laboratory, Division of Clinical Epidemiology, Department of Medicine, Beth Israel Hospital, Boston, Massachusetts

Roger B. Davis

Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Hospital, the Charles A. Dana Research Institute, and the Harvard-Thorndike Laboratory

Lisa I. Iezzoni

Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Hospital, the Charles A. Dana Research Institute, and the Harvard-Thorndike Laboratory

Timely use of necessary follow-up services is an im portant dimension of ambulatory care quality. Using a hospital-based walk-in center, this study identified pa tients who were referred for follow-up care and exam ined factors related to compliance with these referrals. The participants were 696 adults seen in a hospital- based walk-in unit between June 1, 1992, and December 1, 1992. Patients completed a self-administered ques tionnaire including questions about sociodemographic characteristics, prior use of health services, and the Medical Outcomes Study (MOS) 36-Item Health Survey. Medical findings, follow-up recommendations, insur ance status, and compliance with follow-up referrals were ascertained using chart review, the hospital's com puting system, and clinic records. Fifty percent of the patients were referred for follow-up medical care; 55% of these complied with follow-up referrals. Factors asso ciated with referral for follow-up care included older age, inability to afford a physician, longer duration of chief complaint, the patient's belief that follow-up care would be needed, and worse MOS pain score. The most important factor associated with compliance with fol low-up referral was scheduling appointments while pa tients were still in the walk-in unit. Patients with such scheduled appointments were almost 10 times more likely than others to receive follow-up (adjusted odds ratio = 9.6, 95% confidence interval = 4.4-21.2). The most important step a provider can take to improve compliance with follow-up referral is to schedule ap pointments before patients are sent home. This should presumably improve quality of ambulatory care.

American Journal of Medical Quality, Vol. 10, No. 2, 81-87 (1995)
DOI: 10.1177/0885713X9501000204


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