Re: Timely Outpatient Follow-Up Is Associated with Fewer Hospital Readmissions Among Patients with Behavioral Health Conditions

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.