Problems after discharge and understanding of communication with their primary care physicians among hospitalized seniors: A mixed methods study

Abstract

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.

What Do Patients Think About Year-End Resident Continuity Clinic Handoffs?: A Qualitative Study

“…I understand that they are only residents, and every year or every 2 years we get a new resident." 979 Scheduling process (16) "Usually when they make the appointments, they try to arrange them with me to fit my schedule. I go to dialysis and they fix my schedule according to that.…”

“…14,15 Furthermore, patients may be aware of the quality of inter-physician communication during care transitions and may give additional insights into methods to improve communication during clinic handoffs. 16 Therefore, to improve clinic handoffs, more insight into patient experiences and patient needs during this transition are crucial. Our aim was to examine patient perspectives and satisfaction with resident clinic handoffs using semistructured interviews.…”

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

“…[20][21][22][23][24][25][26] Oftentimes, the hospital physician is first introduced to their patient at hospital admission and must rely on the history, physical exam and medical record when making medical decisions. [27][28][29][30][31] For this reason, the hospital physician may be unaware of a patient's drug or alcohol use or mental illness, all risk factors for opioid misuse. [32][33][34] Unfamiliarity between the hospital physician and the patient, and variability in opioid prescribing by hospital physicians, may contribute to chronic opioid use.…”

Use of Hospitalists and Office-Based Primary Care Physicians’ Productivity

“…General concern about the hospitalist model revolves around the break in continuity of care, which ultimately affects quality of care, potentially resulting in medical errors, poor outcomes for patients, and high follow-up costs. [23][24][25][26] Enhanced communication between the hospitalist and the PCP is essential to optimum patient care. Advances in electronic data exchange can help facilitate this communication and reduce the risks associated with discontinuity of care inherent in the hospitalist model.…”