Physician influence on patient compliance: a clinical trial

This study was designed to measure the effect of altering three possible impediments to care provided patients with non-emergency problems in a large city hospital emergency department: inadequate patient education by physician, lack of continuity of care, and complex and impersonal clerical procedures. Patients with symptomatic urinary tract infections were randomly assigned to intervention and control groups. A senior physician spent extra time with patients in the intervention group to discuss the assessment and management of their problem, bypass the usual clerical procedures at discharge, and promise continuity of care. Patients in the control group were treated in the usual fashion by emergency department nurses and residents. The return rate to the emergency department three weeks after the initial visit was used to measure the effect of the altered care applied to patients in the intervention group. Our hypothesis was that patients in the intervention group would be more likely to return. Of 46 patients in the intervention group 26 returned. Of 43 patients in the control group, 14 returned (chi square 4.23 after Yate's correction, 0.025 less than P less than 0.05). The significance of this improvement is discussed.