To the Editor: I commend Dr Nadareh Pourat and colleagues1 for their important work on timely outpatient follow-up and hospital readmissions among patients with behavioral health conditions. I do, however, have a few concerns.
First, the concept of trust in the doctor-patient relationship is an essential one that affects clinical outcomes,2 while distrust has been associated with treatment discordance.3 Thus, patients that were dissatisfied with the inpatient care during the index admission may not be predisposed to attend follow-up or comply with treatment. It would have been informative if their regression models accounted for patient's trust in their health care providers and how it may affect compliance with follow-up, especially in this patient population.
Second, although the authors admirably adjusted for many confounders in their regression models, I wonder if Pourat and colleagues1 considered controlling for anxiety or homelessness/unstable housing, both of which are drivers of hospitalization and readmissions.4,5 It may be interesting and revealing to assess compliance with follow-ups in homeless individuals with behavioral health conditions, such as anxiety disorders, and how both factors might affect timely follow-up outpatient visits.
Acknowledgments
The author is thankful to his research mentor Dr. Linda Cottler for her support.
Notes
To see this article online, please go to: http://jabfm.org/content/32/5/000.full.
The above letter was referred to the author of the article in question, who declined to respond.