Nonadherence with the recommendations of health care providers results in reduced quality of health, poorer social adjustment, and tremendous strain on our already fragile health care economy. This study includes 283 patients evaluated by the Psychiatric Emergency Service (PES) in the emergency room of an 800-bed medical center in an urban setting in the Northeastern United States. Adherence in this study was operationally defined as attending the first outpatient follow-up appointment after referral from the emergency room. Baseline levels of adherence with treatment recommendations were determined in a first group. Patients seen in a second group received a reminder letter as a treatment prompt. In a third group, a set of five Likert Scale questions evaluated the patient's perception of their experience in the emergency room and rated the availability of social supports. Objective aspects of patient care such as the length of time waiting for treatment in the emergency room and length of the interval before the first appointment were also recorded. Other variables such as insurance type, referral site and history of prior treatment at the referral site were studied. Data analysis revealed that the interventions of receiving a reminder letter and completing a questionnaire concerning the emergency room experience both were associated with increased adherence. Several aspects of patient care were also significantly associated with increased adherence, including waiting shorter periods for evaluation, and waiting fewer weeks for the first outpatient appointment. Increased adherence was associated with referral to HMO clinics and private practitioners as compared to referrals to community clinics. Having insurance also was associated with increased adherence, ranked in the following order: HMO insurance, commercial insurance, Medicare, and Medicaid, with the uninsured population having the lowest adherence rates. A history of prior treatment at the referral clinic, being satisfied with emergency room treatment, feeling in need of treatment, and having social supports for treatment all were significantly associated with outpatient referral adherence.
| Identifer | oai:union.ndltd.org:UMASS/oai:scholarworks.umass.edu:dissertations-7633 |
| Date | 01 January 1996 |
| Creators | Benander, Mark K |
| Publisher | ScholarWorks@UMass Amherst |
| Source Sets | University of Massachusetts, Amherst |
| Language | English |
| Detected Language | English |
| Type | text |
| Source | Doctoral Dissertations Available from Proquest |
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