Framework for classifying compliance and medical immediacy among low-acuity presentations at an urban trauma center

Background: This research offers two exploratory frameworks for medical regimen compliance and medical immediacy. The first classifies compliance awareness, compliance mitigation, and financial limitation for those patients that exhibit nonadherence with a medical regimen. The second classifies medical immediacy and characterizes avoidable utilization. Methods: Representative sampling of adult patients presenting at an emergency department (62,000/ppy) triaged as low acuity; emergency department physician assessment of noncompliance with medical regimen for those patients with a complaint related to a chronic condition; and emergency department physician assessment of medical immediacy and avoidable utilization. Results: Physicians report 48.3% (95% confidence interval (CI) 43.5% to 53.1%) of patients with at least a single chronic condition are presenting with symptoms or complaint related a chronic condition, and 39.6% (CI 31.7% to 47.4%) of these exhibit noncompliance with the medical regimen associated with that chronic condition. 16.4% (CI 6.6% to 26.1%) of the patients exhibit pseudo compliance, a belief that the medical regimen is in compliance when in fact it is not. If the patient had been in compliance, 85.9% (CI 77.0% to 94.8%) of the presenting conditions may have been mitigated. Noncompliance cases (34.5% (CI 22.0% to 47.1%)) are partly attributable to financial constraints. Further, 19.1% (CI 15.7% to 22.5%) are assessed as requiring no medical intervention and 3.4% (CI 1.8% to 4.9%) require immediate stabilization. Conclusions: A large portion of low-acuity presentations are related to a chronic condition and noncompliance with the associated medical regimen contributes to the need to seek medical services. Interventions addressing literacy and financial constraints may increase compliance and decrease utilization