Primary care follow-up after Emergency Department discharge for patients with chest pain in Ontario: a scoping review
Bibliographic record
Abstract
Context: Chest pain is one of the most common Emergency Department (ED) complaints, with ~500,000 ED visits annually in Canada. Most patients are safely discharged after ED work-up rules out life-threatening causes. According to clinical guidelines, patients discharged with chest pain should follow-up with a medical doctor (MD) within 72 hours. In Ontario, MD follow-up after ED discharge for chest pain is mostly provided by primary care physicians (PCPs) and sometimes cardiologists. Objective: We explored factors associated with PCP follow-up for patients discharged from Ontario EDs with non-life-threatening chest pain. Study Design: The Joanna Briggs Institute methodology for scoping reviews was used. We searched MEDLINE, EMBASE, CINAHL, and APA PsycINFO in April 2024. Search concepts used were ED, patient discharge, primary care, follow up, Canada, and Ontario. We included primary research articles that studied adult patients (≥18 years) discharged from Ontario EDs with chest pain, who subsequently follow-up with their PCP. Setting: Ontario, Canada. Population Studied: Adults ≥18 years discharged from Ontario EDs with chest pain. Intervention: None. Outcome Measures: Factors associated with PCP follow-up. Results: Among 128 search results, three studies met inclusion criteria. To date, there are no published reviews on this topic. Three observational studies of 273,294 adults discharged with chest pain from Ontario EDs between 2004-10 showed that 58-60% followed up with their PCP within 30 days, which was associated with reduced risk of death or myocardial infarction after one year. 12-17% followed up with a cardiologist, while 25-29% did not see any MD post-discharge. Key predictors for follow-up with any MD included prior PCP visit (OR 6.44, 95% CI 5.91-7.01), cardiologist visit (OR 1.36, 95% CI 1.29-1.42), or hospital admission in the past year (OR 1.27, 95% CI 1.22-1.32). Conversely, patients with multiple co-morbidities or living in rural areas were less likely to follow-up. Conclusions: Most Ontario patients who receive follow-up post-ED discharge for chest pain are seen by PCPs. The strongest predictor for follow-up was established access to an MD, which was associated with better health outcomes. Prioritizing follow-up for at-risk patients is crucial. Strategies include proactive PCP follow-up and improved access to primary care, especially in rural areas. Future research should update these findings within Ontario’s current healthcare context.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.052 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.004 |
| Bibliometrics | 0.014 | 0.028 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".