Factors affecting patient compliance in the acute setting: an analysis of 20,000 imaging reports

The aim of this study was to identify the risk factors associated with noncompliance of recommendations made by emergency radiologists. Between March 2012 and August 2012, our team retrospectively reviewed 20,000 consecutive emergency department (ED) patients receiving imaging to assess how often emergency radiologists made recommendations, how often they were followed, and what factors were associated with noncompliance. Faculty (Radiology or Emergency Medicine) were considered senior if they had been practicing for >5 years post residency/fellowship training. Faculty practicing <5 years were considered junior physicians. The following data was extracted from the electronic medical records and the hospital information system: recommendation in imaging report, age, gender, race (Caucasian, African-American, and others), insurance status, primary care contact, distance from the hospital to patient residence, and primary language. Recommendations were categorized as follows: (1) immediate follow-up, (2) follow-up 1-4 weeks, (3) follow-up 1-3 months, (4) follow-up 4-6 months, (5) follow-up 7-12 months, and (6) clinical/laboratory follow-up recommendations irrespective of time. We identified 1,650 recommendations (1,650/20,000 = 8.25 %). Using a one-to-one logistic regression analysis, the following factors were significant (P < 0.05) when evaluating noncompliance: increasing age, no primary care physician, lack of insurance, primary language other than English, increased distance from hospital, and extended follow-up interval. Noncompliance with recommended additional imaging (RAI) is multifactorial. Primary and/or referring physicians should take notice of the aforementioned compliance trends and mitigating factors, adopt systematic safety measures and create interdepartmental dialogue with radiology to ensure compliance, and counsel and educate patients about the importance of imaging recommendations.