Stroke follow-up in primary care: a discourse study on the discharge summary as a tool for knowledge transfer and collaboration

Abstract

Background The acute treatment for stroke takes place in hospitals and in Norway follow-up of stroke survivors residing in the communities largely takes place in general practice. In order to provide continuous post stroke care, these two levels of care must collaborate, and information and knowledge must be transferred between them. The discharge summary, a written report from the hospital, is central to this communication. Norwegian national guidelines for treatment of stroke, issued in 2010, therefore give recommendations on the content of the discharge summaries. One ambition is to achieve collaboration and knowledge transfer, contributing to integration of the health care services. However, studies suggest that adherence to guidelines in general practice is weak, that collaboration within the health care services does not work the way the authorities intend, and that health care services are fragmented. This study aims to assess to what degree the discharge summaries adhere to the guideline recommendations on content and to what degree they are used as tools for knowledge transfer and collaboration between secondary and primary care. Methods The study was an analysis of 54 discharge summaries for home-dwelling stroke patients. The patients had been discharged from two Norwegian local hospitals in 2011 and 2012 and followed up in primary care. We examined whether content was according to guidelines’ recommendations and performed a descriptive and interpretative discourse analysis, using tools adapted from an established integrated approach to discourse analysis. Results We found a varying degree of adherence to the different advice for the contents of the discharge summaries. One tendency was clear: topics relevant here and now, i.e. at the hospital, were included, while topics most relevant for the later follow-up in primary care were to a larger degree omitted. In most discharge summaries, we did not find anything indicating that the doctors at the hospital made themselves available for collaboration with primary care after dischargeof the patient. Conclusions The discharge summaries did not fulfill their potential to serve as tools for collaboration, knowledge transfer, and guideline implementation. Instead, they may contribute to sustain the gap between hospital medicine and general practice.

Primary care practitioners’ perspectives of discharge communication and continuity of care for stroke survivors in Australia: A qualitative descriptive study

“…This finding suggests that discharge plans are not comprehensive nor timely. These findings are consistent with research indicating weak adherence to stroke guidelines around discharge communication (Breen et al., 2020; Pederson et al., 2021; Weetman et al., 2021). Furthermore, PCPs reported discharge communication usually had minimal input from allied health.…”

“…While stroke recovery begins in the hospital, it continues post discharge when care responsibility transfers to the primary care system (Kernan, 2021). Continuous post stroke care relies upon this transfer of knowledge and information between hospitals and primary care settings (Pederson et al., 2021). Effective discharge communication is required to facilitate continuity of care and improve post discharge support after stroke (Miller et al., 2019; Reeves et al., 2017).…”

Factors influencing follow-up care post-TIA and minor stroke: a qualitative study using the theoretical domains framework

“…Similarly, in primary care, research shows disparity in GPs’ perception of their role in cardiovascular disease prevention, in particular lifestyle advice, and patient factors were important influences on GPs actions [ 20 , 21 ]. We identified sub-optimal and variable interface communication between healthcare settings, which is supported by other stroke research [ 22 ]..…”

The impact of stroke, cognitive function and post-stroke cognitive impairment (PSCI) on healthcare utilisation in Ireland: a cross-sectional nationally representative study

“…GPs are often the first point of contact for stroke survivors discharged to the community [ 11 ], and these practitioners are responsible for managing a stroke patient’s secondary prevention treatment, identifying post-stroke rehabilitation needs and facilitating referral to appropriate services [ 10 , 23 , 50 ]. However, research suggests that these recommendations are not routinely implemented in practice [ 51 , 52 ] and patients with complex post-stroke cognitive and psychological difficulties often require stroke-specific expertise [ 53 ].…”