Emergency Department Follow-up for Adults with Sickle Cell Disease.

To report the patients' ability to make and keep follow-up appointments, obtain analgesic prescriptions, and continued presence of pain for adult emergency department (ED) patients with sickle cell disease, seven and 30 days post ED visit. Barriers to making and keeping appointments and filling analgesic prescriptions were explored.

A multi-center, prospective, longitudinal surveillance study enrolled patients from three academic medical centers (rural and urban). All ED patients ≥18 years with a chief complaint of a sickle cell pain episode were eligible for inclusion. Patients participated in an initial interview within 14 days of their ED visit and/or a second interview 21–37 days from their ED visit. Patients were interviewed at most once per month. The initial interview was conducted either during the hospitalization if admitted, or by follow-up phone call. The 2^nd interview was conducted by phone. Pain scores at the time of both interviews were obtained. During the 2^nd interview patients were asked if they were able to (1) make and keep a follow-up appointment, (2) whether or not they received and were able to fill an analgesic prescription and (3) associated barriers to either. Each study site conducted a minimum of 10 interviews per quarter. The study period was from October 2007 through July 2009. Descriptive statistics were used to report the data. A paired t-test was used to analyze differences in 7 and 30 day pain scores. Qualitative analysis was used to analyze free text barrier responses to making and keeping an appointment and filling prescriptions.

One hundred fifty seven initial interviews and 108 second interviews were completed, 80 different patients, 51% male, mean age 34±10, ages 18–51. Sixty six percent of patients reported they were able to obtain an appointment with a primary care physician after discharge. Of those with difficulty getting an appointment, barriers included: patient did not attempt to obtain an appointment (24%), no current appointments available (21%), difficulty getting a hold of MD office (18%), difficulty finding an MD (15%), no time to go to appointment (9%), lost MD phone number (6%), unspecified (6%), and no money for appointment (3%). Sixty six percent of patients with an appointment reported keeping their appointment or had a future appointment scheduled. Reasons why patients did not keep their appointment included: had to work, out of town, in hospital before appointment, forgot when appointment was, no money for appointment. At discharge from the ED or hospital, 70% of patients reported they needed an analgesic prescription and 66% of patients received a prescription for analgesics. Nineteen percent of patients reported difficulty filling their prescription. Difficulties included: prescription written incorrectly, dose was not available at pharmacy, pharmacy was closed, no money for prescription, homeless. Initial interview pain scores (median, IQR) were 7; (6.25, 8), and 2^nd interview pain scores were 8; (7, 9). 57 patients participated in both an initial and follow-up interview and no differences in pain scores were reported, (p=0.83). Forty three percent of patients (who were discharged home from the ED) during the initial interview, and 59% of patients during the 2^nd interview reported being unable to manage their pain at home. On the second interview, 74% of patients reported they were currently experiencing sickle cell pain and 72% reported they were taking pain medication every day.

Many ED patients did not keep follow-up appointments and a smaller number of patients experienced barriers to filling analgesic prescriptions. Over half of patients reported continued pain in the severe range 30 days after the ED visit.

Tanabe:NIH, and Mayday Fund: Research Funding. Hafner:Mayday Fund: Research Funding. Martinovich:Mayday Fund: Research Funding. Zvirbulis:Mayday Fund: Research Funding. Artz:Mayday Fund: Research Funding.