Investigating discharge communication for chronic disease patients in three hospitals in India.

ABSTRACT

OBJECTIVES: Poor discharge communication is associated with negative health outcomes in high-income countries. However, quality of discharge communication has received little attention in India and many other low and middle-income countries. PRIMARY OBJECTIVE: To investigate verbal and documented discharge communication for chronic non-communicable disease (NCD) patients. SECONDARY OBJECTIVE: To explore the relationship between quality of discharge communication and health outcomes. DESIGN: Prospective study. SETTING: Three public hospitals in Himachal Pradesh and Kerala states, India. PARTICIPANTS: 546 chronic NCD (chronic respiratory disease, cardiovascular disease or diabetes) patients. Piloted questionnaires were completed at admission, discharge and five and eighteen-week follow-up covering health status, discharge communication practices and health-seeking behaviour. Logistic regression was used to explore the relationship between quality of discharge communication and health outcomes. PRIMARY Patient recall and experiences of verbal and documented discharge communication. SECONDARY Death, hospital readmission and self-reported deterioration of NCD/s. RESULTS: All patients received discharge notes, predominantly on sheets of paper with basic pre-printed headings (71%) or no structure (19%); 31% of notes contained all the following information required for facilitating continuity of care diagnosis, medication information, lifestyle advice, and follow-up instructions. Patient reports indicated notable variations in verbal information provided during discharge consultations; 50% received ongoing treatment/management information and 23% received lifestyle advice. Within 18 weeks of follow-up, 25 (5%) patients had died, 69 (13%) had been readmitted and 62 (11%) reported that their chronic NCD/s had deteriorated. Significant associations were found between low-quality documented discharge communication and death (AOR = 3.00; 95% CI 1.27,7.06) and low-quality verbal discharge communication and self-reported deterioration of chronic NCD/s (AOR = 0.46; 95% CI 0.25,0.83) within 18-weeks of follow-up. CONCLUSIONS: Sub-optimal discharge practices may be compromising continuity and safety of chronic NCD patient care. Structured protocols, documents and training are required to improve discharge communication, healthcare integration and NCD management.