Impact of providing patients with copies of their medical correspondence: a randomised controlled study

Fenton, Clare; Al‐Ani, Aysha; Trinh, Andrew; Srinivasan, Alagarsamy; Marion, Kaye; Hebbard, GS

doi:10.1111/imj.13252

Cited by 6 publications

(20 citation statements)

References 17 publications

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“…The study participants, in line with past studies [15][16][17][18][19][20][21][22][23][24]65], showed high rates of preference for receiving letters. Sending patients direct copies of GP letters was not only favoured by many of the patients but could save time and resources through eradicating the need to produce two separate discharge letters (i.e.…”

Section: Implications For Practicesupporting

confidence: 85%

“…Generally, participants' opinions about receiving copies of letters were viewed as a matter of personal preference rather than specific to particular specialties or episodes of care. Participants felt patients should be offered a choice about when and whether they wish to receive a copy letter, a view supported by findings from past studies [8,16,19,60]. Responses seemed to exhibit preference for "opt-out" letter receipt systems which would account for individuals who do not want letters whilst still allowing the majority of patients to receive letters.…”

Section: Key Findingsmentioning

confidence: 74%

“…Despite past studies reporting high rates of patient preference for receiving letters [15][16][17][18][19][20][21][22][23][24], previous literature has reported inconsistency of this practice [7,8]. Prior to this study we conducted a realist review [10] relating to this topic which found that whilst there is research and guidance that argues for the benefits of copies of discharge letters, there is little evidence about the specific contexts in which this may or may not be helpful [9,10].…”

Section: Introductionmentioning

confidence: 99%

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Adult patient perspectives on receiving hospital discharge letters: a corpus analysis of patient interviews

Weetman

Dale

Scott

et al. 2020

BMC Health Serv Res

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Background: UK government guidelines and initiatives emphasise equity in delivery of care, shared decisionmaking, and patient-centred care. This includes sharing information with patients as partners in health decisions and empowering them to manage their health effectively. In the UK, general practitioners (GPs) routinely receive hospital discharge letters; while patients receiving copies of such letters is seen as "good practice" and recommended, it is not standardised. The effects and consequences of whether or not this happens remains unclear. The aim of this study (one of three forming the Discharge Communication Study) was to explore patient perspectives on receiving discharge letters and their views on how this could be improved in order to optimise patient experience and outcomes. Methods: Semi-structured interviews were conducted with a diverse sample of 50 patients recruited from 17 GP surgeries within the West Midlands, UK. All participants were adults with a recent episode of general hospital inpatient or outpatient care. Data were audio recorded, transcribed and analysed using mixed methods corpus linguistics techniques. Results: Participants reported inconsistent access to discharge letters. Most wanted to receive a copy of their discharge letter although some expressed reservations. Perceived benefits included: increased understanding of their condition and treatment, reduced anxiety, and increased satisfaction. Consequences where participants had not received letters included: letter inaccuracies being overlooked, missed follow up actions, failure to fully remember diagnosis, treatment, or self-management or recommendations, and confusion and anxiety at what occurred and what will happen next. Participants felt the usefulness of receiving copies of letters could be increased by: including a patient information section, avoidance of acronyms, and jargon or technical terms explained with lay language.

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Section: Implications For Practicesupporting

confidence: 85%

Section: Key Findingsmentioning

confidence: 74%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Adult patient perspectives on receiving hospital discharge letters: a corpus analysis of patient interviews

Weetman

Dale

Scott

et al. 2020

BMC Health Serv Res

View full text Add to dashboard Cite

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“…Past studies, across a range of settings, report that patient preference for receiving letters is high (79%-97%) [39][40][41][42][43][44][45][46] ; this study supports this finding as patients generally indicated preference for discharge letter receipt. Despite this, both GPs and patients noted the inconsistent practice of patients receiving letters.…”

Section: Patient Preference/choicesupporting

confidence: 80%

Discharge communication study: a realist evaluation of discharge communication experiences of patients, general practitioners and hospital practitioners, alongside a corresponding discharge letter sample

et al. 2021

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ObjectivesTo develop a programme theory for the intervention of patients receiving discharge letters.DesignWe used a realist evaluation approach and captured multiple perspectives of hospital discharge to refine our previously developed programme theory. General practitioner (GP), patient and hospital clinician views of a single discharge event in which they were all involved were collected using semi-structured interviews and surveys. These were then triangulated to match the corresponding discharge letter. Data were qualitatively synthesised and compared in meta-matrices before interrogation with realist logic of analysis to develop the programme theory that maps out how patients receiving discharge letters works in specific contexts.Setting14 GP practices and four hospital trusts in West Midlands, UK.Participants10 complete matched cases (GP, patient and hospital practitioner), and a further 26 cases in which a letter was matched with two out of the three participants.ResultsWe identified seven context mechanism outcome configurations not found through literature searching. These related to the broad concepts of: patient preference for receiving letters, patient comprehension of letters, patient-directed letters, patient harm and clinician views on patients receiving letters. ‘Patient choice’ was important to the success (or not) of the intervention. Other important contexts for positive effects included: letters written in plain English, lay explanations for jargon, verbal information also provided, no new information in letter and patient choice acknowledged. Three key findings were: patient understanding is perhaps greater than clinicians perceive, clinician attitudes are a barrier to patients receiving letters and that, negative outcomes more commonly manifested when patients had not received letters, rather than when they had.ConclusionsWe suggest how patients receiving discharge letters could be improved to enhance patient outcomes. Our programme theory has potential for use in different healthcare contexts and as a framework for policy development relating to patient discharge.

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“…The initiative encourages doctors to write directly to patients in simple plain English to increase understanding. Despite these initiatives and guidelines, evidence within and outside the UK reports both benefits6–10 (eg, patient satisfaction), and drawbacks11–15 (eg, patient confusion) of patients receiving their letters. While patients receive copies of discharge letters inconsistently,16 17 the reasons for this and the subsequent consequences remain unclear.…”

Section: Introductionmentioning

confidence: 99%

Improving best practice for patients receiving hospital discharge letters: a realist review

et al. 2019

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ObjectiveTo understand how different outcomes are achieved from adult patients receiving hospital discharge letters from inpatient and outpatient settings.DesignRealist review conducted in six main steps: (1) development of initial theory, (2) searching, (3) screening and selection, (4) data extraction and analysis, (5) data synthesis and (6) programme theory (PT) refinement.Eligibility criteriaDocuments reporting evidence that met criteria for relevance to the PT. Documents relating solely to mental health or children aged <18 years were excluded.AnalysisData were extracted and analysed using a realist logic of analysis. Texts were coded for concepts relating to context, mechanism, outcome configurations (CMOCs) for the intervention of patients receiving discharge letters. All outcomes were considered. Based on evidence and our judgement, CMOCs were labelled ‘positive’ or ‘negative’ in order to clearly distinguish between contexts where the intervention does and does not work.Results3113 documents were screened and 103 were included. Stakeholders contributed to refining the PT in step 6. The final PT included 48 CMOCs for how outcomes are affected by patients receiving discharge letters. ‘Patient choice’ emerged as a key influencer to the success (or not) of the intervention. Important contexts were identified for both ‘positive’ CMOCs (eg, no new information in letter) and ‘negative’ CMOCs (eg, letter sent without verifying patient contact details). Two key findings were that patient understanding is possibly greater than clinicians perceive, and that patients tend to express strong preference for receiving letters. Clinician concerns emerged as a barrier to wider sharing of discharge letters with patients, which may need to be addressed through organisational policies and direction.ConclusionsThis review forms a starting point for explaining outcomes associated with whether or not patients receive discharge letters. It suggests several ways in which current processes might be modified to support improved practice and patient experience.

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Impact of providing patients with copies of their medical correspondence: a randomised controlled study

Cited by 6 publications

References 17 publications

Adult patient perspectives on receiving hospital discharge letters: a corpus analysis of patient interviews

Adult patient perspectives on receiving hospital discharge letters: a corpus analysis of patient interviews

Discharge communication study: a realist evaluation of discharge communication experiences of patients, general practitioners and hospital practitioners, alongside a corresponding discharge letter sample

Improving best practice for patients receiving hospital discharge letters: a realist review

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