Patient and healthcare provider knowledge, attitudes and barriers to handover and healthcare communication during chronic disease inpatient care in India: a qualitative exploratory study

Abstract

Objectives1) To investigate patient and healthcare provider (HCP) knowledge, attitudes and barriers to handover and healthcare communication during inpatient care. 2) To explore potential interventions for improving the storage and transfer of healthcare information.DesignQualitative study comprising 41 semi-structured, individual interviews and a thematic analysis using the Framework Method with analyst triangulation.SettingThree public hospitals in Himachal Pradesh and Kerala, India.ParticipantsParticipants included 20 male (n=10) and female (n=10) patients with chronic non-communicable disease (NCD) and 21 male (n=15) and female (n=6) HCPs. Purposive sampling was used to identify patients with chronic NCDs (cardiovascular disease, chronic respiratory disease, diabetes or hypertension) and HCPs.ResultsPatient themes were (1) public healthcare service characteristics, (2) HCP to patient communication and (3) attitudes regarding medical information. HCP themes were (1) system factors, (2) information exchange practices and (3) quality improvement strategies. Both patients and HCPs recognised public healthcare constraints that increased pressure on hospitals and subsequently limited consultation times. Systemic issues reported by HCPs were a lack of formal handover systems, training and accessible hospital-based records. Healthcare management communication during admission was inconsistent and lacked patient-centredness, evidenced by varying reports of patient information received and some dissatisfaction with lifestyle advice. HCPs reported that the duty of writing discharge notes was passed from senior doctors to interns or nurses during busy periods. A nurse reported providing predominantly verbal discharge instructions to patients. Patient-held medical documents facilitated information exchange between HCPs, but doctors reported that they were not always transported. HCPs and patients expressed positive views towards the idea of introducing patient-held booklets to improve the organisation and transfer of medical documents.ConclusionsHandover and healthcare communication during chronic NCD inpatient care is currently suboptimal. Structured information exchange systems and HCP training are required to improve continuity and safety of care during critical transitions such as referral and discharge. Our findings suggest that patient-held booklets may also assist in enhancing handover and patient-centred practices.

Fatores que influenciam para transferência do cuidado intra-hospitalar efetiva: Revisão integrativa

“…A comunicação, considerada um dos principais elementos da transferência do cuidado, é utilizada para compreender e atender as necessidades dos pacientes, coordenar o cuidado e partilhar informações (Tacchini-Jacquier et al, 2020). Além disso, a troca de informações entre os profissionais de saúde, durante a transferência do cuidado, é uma etapa fundamental, pois é por meio da qualidade da comunicação que as informações relevantes são compartilhadas e compreendidas pelos profissionais (Humphries et al, 2019). Frente a isso, autores definem a comunicação como a passagem de informações de um indivíduo para o outro através de qualquer canal de comunicação, como: conversa face a face, telefone, registros escritos, fontes de informações formal e prontuários (Popovici et al, 2015).…”

“…O trabalho em equipe é considerado uma parte complexa da transferência do cuidado, visto que, em muitas situações, envolve o relacionamento entre equipes de diferentes unidades de cuidado, o que designa um desafio para realização de transferências efetivas (Germack et al, 2020;Humphries et al, 2019). Frente a isso, O'Connor et al ( 2020), afirmam que a dificuldade de trabalhar em equipe, durante as transferências do cuidado, está associada a falta de conhecimento sobre os cuidados a serem realizados por cada membro das equipes e por informações divergentes entre as mesmas, repercutindo em ações desorganizadas para o recebimento e a continuidade da assistência prestada ao paciente.…”

World Heart Federation Roadmap for Hypertension – A 2021 Update

“…Communication gaps between patients and providers [ 100 ], poor clinical handover or patients discontinuing medications for hypertension due to inadequate awareness of the importance of lifelong medications [ 101 102 ] are well-documented barriers to optimal care for chronic conditions in low resource settings. Patient and carer education is therefore perceived as an important strategy to improve hypertension management in primary care settings [ 103 ].…”

Systematic review on the use of patient-held health records in low-income and middle-income countries

“…Although only one study addressed these, the inadequate completeness of the information documented by HCPs, and a lack of protocols and training on the use of PHRs, are both likely to be prominent issues in all the settings as evidenced by the wider literature on training and protocols for medical records documentation. 43–45 The PHRs were perceived as useful by HCPs for documenting the medical history of patients, thus improving the availability of medical information. From the patient perspective, the PHR functioned as a reminder for medication, improved self-care efficacy and enabled continuity of care by providing relevant clinical information to all HCPs involved in patient care.…”