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Community Primary Care Provider Preferences for Emergency Department Follow-up Recommendations: A Regional Study
Marissa A Hendrickson1, Eta Obeya, Andrew R Wey
1From the *Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Minnesota Medical School and University of Minnesota Masonic Children's Hospital; and †Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN; ‡Biostatistics and Data Management Core, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI; and §Department of Mathematics and Statistics, Auburn University, Auburn, AA.
Background:
Children who present to emergency departments (EDs) for care are frequently advised to follow up with their primary care providers (PCPs) after discharge; little is known about whether PCPs agree that follow-up advised by EDs is appropriate for their patients.
Objectives:
The aims of this study were to determine PCP preferences for follow-up recommendations given to their pediatric patients at the time of ED visits and to compare these preferences to reported emergency medicine provider (EMP) practice.
Methods:
This was an online survey of PCPs and EMPs in a regional health system assessing preferred timing for ED follow-up recommendations for 15 common pediatric conditions and whether the follow-up should be definite or contingent.
Results:
Ninety PCPs and 36 EMPs responded to the survey. In patients with community-acquired pneumonia, probability of recommending follow-up after 5 or more days was 33% in PCPs and 8% in EMPs (P = 0.001). In all conditions with significant differences, PCPs favored longer follow-up. In upper respiratory tract infection and acute otitis media, PCPs had a higher probability than EMPs of selecting as-needed versus definite follow-up (P = 0.0002 and P = 0.01, respectively). In asthma, concussion, and pneumonia, PCPs had a significantly lower probability of selecting as-needed follow-up than EMPs.
Conclusions:
In this regional survey, PCPs preferred longer times between ED visit and follow-up than EMPs for a number of conditions. Differences were also found in preference for as-needed or definite follow-up, varying by condition. These discrepancies could result in overuse or underuse of clinic resources, suggesting a possible quality improvement target for emergency medicine practice.
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