Background Communication and coordination with primary care physicians (PCPs) is recommended to ensure safe care transitions for hospitalized older patients. Understanding patient experiences of problems after discharge can help clinical teams design more patient-centered care transitions. Objective To report older patients’ experiences with problems after hospital discharge and investigate whether PCPs were aware of their hospitalization Design Prospective mixed methods study Setting Single academic medical center Patients Hospitalized patients and PCPs Measurements Telephone interviews of older frail general medical patients conducted two weeks after discharge to elicit patient problems after discharge, such as obtaining medications, or follow-up appointments; and 2) perceptions of hospital physician communication with their PCP. For each patient interviewed, their PCP was faxed a survey two weeks after discharge to assess awareness of hospitalization. Results Forty-two percent (27) of patients reported 42 different post-discharge problems. The most frequently reported problems were difficulty with follow-up appointments or tests (12). Other reported problems included readmission and return to the Emergency Department (10), problems with medications (8), not-prepared for discharge (8), and hospital complications or questions (4). Thirty percent of PCPs were unaware of patient hospitalization. Patients were twice as likely to report a problem if their PCP was unaware of the hospitalization (31% PCP aware, vs. 67% PCP not aware; p<0.05). Conclusion This study suggests that many frail older patients reported problems after discharge and were twice as likely to do so when the patient’s PCP was not aware of the hospitalization. Systematic interventions to improve communication with PCPs during patient hospitalization are needed.

While most patients were scheduled for appointments after a clinic handoff, many did not see the correct resident and one-fifth were lost to follow-up. Patients who miss appointments are especially at risk of poor clinic handoff outcomes. Future efforts should improve patient attendance to their first new PCP visit and increase PCP ownership.

Purpose Relative supersaturations of calcium oxalate, calcium phosphate, and uric acid are used clinically in kidney stone prevention. The magnitudes of association between relative supersaturation and stone risk require further quantification. Materials and Methods We performed a cross-sectional study using 24-hour urine collections from Nurses’ Health Study I (NHS I), Nurses’ Health Study II (NHS II), and Health Professional Follow-up Study (HPFS) cohorts to quantify the association between calcium oxalate, calcium phosphate, and uric acid relative supersaturations levels and likelihood of stone formation. Results: Odds ratio (OR) for being a stone former were 5.85 (3.40 to 10.04) in NHS I, 6.38 (3.72 to 11.0) in NHS II, and 6.95 (3.56 to 13.6) in HPFS for the highest category of calcium oxalate relative supersaturation compared with <1.0. The OR for being a stone former were 1.86 (0.94 to 3.71) in NHS I, 4.37 (2.68 to 7.10) in NHS II, and 3.59 (2.04 to 6.31) in HPFS for the highest category of calcium phosphate relative supersaturation compared with <1.0. For uric acid relative supersaturation, OR for being a stone former were 4.30 (2.34 to 7.90) in NHS I and 2.74 (1.71 to 4.40) in NHS II for the highest relative supersaturation category compared with <1.0. In HPFS, uric acid relative supersaturation was not significantly associated with likelihood of stone formation. Conclusion Likelihood of being a stone former increases with higher calcium oxalate and calcium phosphate relative supersaturation levels in men and women, and higher relative supersaturation levels of uric acid in women.

Postmenopausal status is associated with a higher risk of incident kidney stones. Natural menopause and surgical menopause are independently associated with higher risk. There are small but significant differences in urine composition between premenopausal and postmenopausal urine collections.