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Follow-up compliance in febrile children: a comparison of two systems
R R Hemphill1, S A Santen, J M Howell
1Joint Military Medical Centers, Emergency Medicine Residency, San Antonio, TX, USA.
Insights
Ensuring follow-up care for febrile children is crucial. A system with prearranged, free appointments significantly improves follow-up compliance compared to systems requiring parents to schedule and pay for visits.
Area of Science:
- Pediatrics
- Public Health
- Health Services Research
Background:
- Follow-up compliance in febrile children is essential due to the potential for serious underlying conditions.
- Existing healthcare systems present varied approaches to post-emergency department (ED) care, impacting patient adherence.
Purpose of the Study:
- To compare follow-up compliance rates between two distinct healthcare systems for febrile children.
- To identify factors influencing follow-up compliance in this pediatric population.
Main Methods:
- A prospective, observational study was conducted across two emergency departments (EDs) with differing follow-up protocols.
- Data on diagnosis, follow-up compliance, and demographics were collected from ED records and parental contact.
- Statistical analysis included logistic regression and chi-squared tests.
Main Results:
- Children in the Wilford Hall Medical Center (WHMC) system with prearranged, free appointments showed higher follow-up compliance (92%) than those in the Fairfax Hospital (FFX) system (67%).
- Factors associated with noncompliance included Hispanic ethnicity, non-English-speaking parents, and delayed follow-up recommendations (>24 hours).
- For the FFX system, self-pay status, lack of a designated follow-up physician, and parental dissatisfaction were also linked to noncompliance.
Conclusions:
- Healthcare systems that provide prearranged appointments and free medical care enhance follow-up compliance for febrile children.
- Implementing models similar to WHMC could improve adherence to recommended follow-up care, thereby potentially reducing risks associated with missed diagnoses.
Objectives:
Follow-up compliance is critical in febrile children because they may harbor unrecognized life-threatening illnesses. This study compares follow-up rates between 2 systems: Wilford Hall Medical Center (WHMC), with preset appointments after ED release, and free medical care; and Fairfax Hospital (FFX), where parents must arrange follow-up appointments after ED release, and are responsible for payment for their follow-up visits. The study also investigated factors associated with follow-up compliance.
Methods:
This was a prospective, observational study of febrile children seen in 2 EDs with different systems for patient follow-up. From ED records and parental phone calls, diagnosis, follow-up compliance, and demographics were collected. Data were analyzed using logistic regression and chi2.
Results:
423 children met entrance criteria, and 330 parents were successfully contacted after the child's ED release (146 from WHMC; 184 from FFX). The WHMC children were more likely to comply with follow-up than were the children in the FFX system (92% vs 67% follow-up, odds ratio 2.5, 95% CI 1.1-5.3). Other factors associated with noncompliance with recommended follow-up were: Hispanic ethnicity, non-English-speaking parents, and follow-up suggested for >24 hours after ED release. For FFX, self-pay, lack of a follow-up physician, parents' dissatisfaction with the ED medical care, and diagnosis of otitis media were also significant factors found associated with noncompliance.
Conclusion:
Febrile children evaluated in a medical system with prearranged follow-up appointments and free medical care are more likely to comply with recommended follow-up than are those evaluated in a system where payment and appointments are the responsibility of the parents. Efforts should be made to improve follow-up compliance by modeling the WHMC system.
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