Community Primary Care Provider Preferences for Emergency Department Follow-up Recommendations: A Regional Study

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Abstract

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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