Factors associated with attendance at primary care appointments after discharge from hospital: a retrospective cohort study

Kenneth Lam; Howard B Abrams; John Matelski; Karen Okrainec

doi:10.9778/cmajo.20180069

Factors associated with attendance at primary care appointments after discharge from hospital: a retrospective cohort study

CMAJ Open. 2018 Dec 3;6(4):E587-E593. doi: 10.9778/cmajo.20180069. Print 2018 Oct-Dec.

Authors

Kenneth Lam¹, Howard B Abrams², John Matelski², Karen Okrainec²

Affiliations

¹ Department of Medicine (Lam, Abrams, Okrainec), University of Toronto; Division of General Internal Medicine (Abrams, Okrainec), University Health Network; Biostatistics Research Unit (Matelski), University Health Network, Toronto, Ont. [email protected].
² Department of Medicine (Lam, Abrams, Okrainec), University of Toronto; Division of General Internal Medicine (Abrams, Okrainec), University Health Network; Biostatistics Research Unit (Matelski), University Health Network, Toronto, Ont.

Abstract

Background: Follow-up with a primary care provider within 1-2 weeks of discharge from hospital has been associated with reduced readmissions. We sought to determine appointment attendance with primary care providers postdischarge and identify factors associated with attendance.

Methods: We conducted a retrospective cohort study involving general medicine patients who had been discharged from hospital between Sept. 1, 2014, and Dec. 30, 2015, from 2 Ontario academic hospitals, and who had been supported by a transitional care specialist and advised to see a primary care provider within 1 week. Attendance was determined by self-report during follow-up by telephone. We used multivariable logistic regression to assess whether patient factors (e.g., comorbidity) or system factors (e.g., booking the appointment before discharge) predicted attendance. We used Cox proportional hazards modelling to assess whether attendance predicted readmission within 30 days.

Results: Of the 214 patients included in our study, 35% (n = 75) attended a primary care appointment within 1 week of discharge; 52% (n = 124) of patients attended an appointment within 2 weeks. After adjusting for age, sex and comorbidity, significant predictors of attendance were booking the appointment before discharge (odds ratio [OR] 2.14, 95% confidence interval [CI] 1.07-4.40), familiarity with the primary care provider (OR 5.43, 95% CI 2.25-14.1) and inclusion of a reminder, callback number and appointment time in the discharge summary (OR 15.3, 95% CI 2.09-326). Predictors of nonattendance were the presence of a home support worker (OR 0.38, 95% CI 0.17-0.80) and a booked specialist appointment before discharge (OR 0.37, 95% CI 0.18-0.73). Attendance was not associated with reduced readmissions (hazard ratio 0.66, 95% CI 0.40-1.09).

Interpretation: Timely follow-up with PCPs postdischarge remains challenging. Efforts to improve attendance should focus on reinforcing need for follow-up and coordinating follow-up before discharge, particularly for those poorly connected with the health care system.