Patient Follow-up After Consultation in Emergency Department

Each year more than 15 million French people visit the emergency services and almost 80% of them come out without hospitalization after having undergone a clinical examination and possibly additional examinations.

Study Overview

• Status: Completed
• Conditions: Emergency; Consultation
• Intervention / Treatment: Other: Discharge from patient after consultation in emergency department

Detailed Description

Each year more than 15 million French people visit the emergency services and almost 80% of them come out without hospitalization after having undergone a clinical examination and possibly additional examinations.

Following their discharge, compliance with discharge requirements and recommendations (treatment, monitoring, follow-up, etc.) is a determining factor in improving their health. Non-membership is linked to an increase in morbidity, mortality and use of the health system. Patient adherence to discharge instructions is conditional on patient understanding. Unfortunately, the environment of an emergency service often creates conditions for information and education of the patient that are often far from optimal or at least that are specific to a typical consultation.

Data from the international literature showed that 78% of people who come out of emergency after consultation do not clearly understand the instructions and only 20% are aware of their lack of understanding. Waisman et al. Documented that 25% of patients did not understand their diagnosis and that 13% to 18% did not understand treatment instructions. Heng et al. Have shown that patients leaving after head trauma are unable to cite the symptoms that should prompt them to consult quickly.

The involvement of healthcare teams to inform patients with the help of different communication media is therefore particularly important in trying to improve understanding and adherence to exit instructions. However, Zavala et al. Point to the fact that this is not necessarily sufficient.

Some authors have identified factors of poor adherence: multiple chronic diseases, multiple drug treatments, psychiatric disorders, but also age, social isolation, depression, quality of life and socio-economic and cultural level , A low level of health literacy, or planned medical follow-up, the severity of the pathology and the perception of that severity by the patient, or the patient's dissatisfaction with medical instructions.

The patients' adherence to the literature is evaluated in a varied manner according to the pathologies concerned: counting the number of tablets; Patient self-tracking log; Reports from physicians, reports by third parties (such as the patient's spouse); Electronic measurements (for example, metered-dose inhalers or electronic drop dispensers); Blood or urine dosage. The different methods used have advantages and disadvantages that need to be assessed according to the needs of the study we wish to implement. While declarative investigations in the assessment of patient adherence are criticized, no method has unfortunately been used as a benchmark for assessing adherence. The bibliographic search did not find any questionnaires that had been validated in this context. In order to evaluate the adhesion, the investigator will therefore opt for a semi-directed interview at D7 in order to better control a possible bias of memorization. This tool has known limitations including a tendency to overestimate adhesion, because patients tend to respond to what doctors want to hear. This will be taken into account in the interpretation of the results.

• Study Type: Interventional
• Enrollment (Actual): 242
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Maxime GIGNON, Dr; Phone Number: +33322667606; Email: gignon.maxime@chu-amiens.fr

Study Locations

• France
  • Picardie
    • Amiens, Picardie, France, 80054
      • CHU Amiens Picardie

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Major patient not benefiting from any legal protection measures.
• Speaking French.
• Outgoing after having received a consultation in a hospital emergency department.
• Accepting to participate in the study after being informed of the protocol.
• Having the possibility to be reached by telephone on J7.

Exclusion Criteria:

• Patient with a pathology that does not allow him or her to understand instructions or express themselves.
• Patient under tutelage or curatorship or deprived of all freedom.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Patient with an interview	Other: Discharge from patient after consultation in emergency department; Discharge from patient after consultation in emergency department
Other: Patient without an interview	Other: Discharge from patient after consultation in emergency department; Discharge from patient after consultation in emergency department

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Analysis of patient compliance with discharge	Analysis of patient compliance with discharge orders issued after consultation in emergencies determined by telephone interview	7 days

Collaborators and Investigators

• Sponsor: Centre Hospitalier Universitaire, Amiens

Study record dates

Study Major Dates

• Study Start (Actual): November 26, 2013
• Primary Completion (Actual): August 1, 2019
• Study Completion (Actual): August 25, 2019

Study Registration Dates

• First Submitted: April 5, 2017
• First Submitted That Met QC Criteria: April 14, 2017
• First Posted (Actual): April 17, 2017

Study Record Updates

• Last Update Posted (Actual): May 17, 2023
• Last Update Submitted That Met QC Criteria: May 16, 2023
• Last Verified: May 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: PI2013_843_0012

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No