Self-reported Discharge Instruction Adherence Among Different Racial Groups Seen in the Emergency Department

Objectives: To compare emergency department (ED) discharge instructions adherence rates and barriers faced by white, black, and Hispanic patients. Methods: A 6-month prospective follow-up study was conducted in a suburban tertiary care facility. Subjects were adult (>17 years) ED patients discharged with a specific instruction to follow-up with a physician within 2 weeks. Excluded subjects were mentally impaired, evaluated by psychiatry, or institutionalized. Subjects completed a telephone interview within 4 weeks to determine adherence to follow-up and the filling of any prescription given them. Results: Of 268 white, 141 black, and 64 Hispanic eligible persons, 133 (53.1%) white, 69 (48.9%) black, and 49(76.6%) Hispanic subjects participated. Adherence for follow-up and prescription, respectively, was 62.4% and 83.7% in whites, 56.5% and 86.7% in blacks, and 53.1% and 94.5% in Hispanics (nonsignificant chi(2) test). White subjects were more likely to report feeling better as a reason for noncompliance (30%), while black (49%) and Hispanic (34%) subjects were more likely to have difficulty getting a follow-up appointment. Conclusion: Black and Hispanic patients were more likely than white patients to report difficulty in getting a follow-up appointment within a 2-week period, even though overall adherence was statistically similar between groups. Despite varied level of uninsured patients within each racial group, perceived follow-up cost was not found to be a major barrier. This suggests that improving adherence for a diverse population will require addressing institutional barriers such as appointment wait times and physician-patient ratios in addition to current efforts to increase access to care.