Problems After Discharge and Understanding of Communication With Their Primary Care Physicians Among Hospitalized Seniors: A Mixed Methods Study
Problems After Discharge and Understanding of Communication With Their Primary Care Physicians Among Hospitalized Seniors: A Mixed Methods Study
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DOI：
10.1002/jhm.668
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发表时间：
2010-09-01
影响因子：
2.6
通讯作者：
Johnson, Julie K.
中科院分区：
文献类型：
--
作者：
Arora, Vineet M.;Prochaska, Megan L.;Johnson, Julie K.
背景：建议与初级保健医生 (PCP) 进行沟通和协调，以确保住院老年患者的安全护理过渡。了解患者出院后的问题经历可以帮助临床团队设计更多以患者为中心的护理过渡。目的：报告老年患者出院后遇到问题的经历，并调查 PCP 是否了解其住院情况。设计：前瞻性混合方法研究。地点：单一学术医疗中心。患者：住院患者和 PCP。测量：出院后 2 周对体弱的老年普通内科患者进行电话访谈，以了解出院后的患者问题，例如： (1) 获取药物或后续预约； (2) 对医院医生与其 PCP 沟通的看法。对于每一位接受采访的患者，他们的 PCP 在出院后 2 周都会收到一份调查传真，以评估其住院意识。 结果：百分之四十二 (27) 的患者报告了 42 种不同的出院后问题。最常报告的问题是后续预约或测试困难 (12)。其他报告的问题包括重新入院和返回急诊室 (10)、药物问题 (8)、未做好出院准备 (8) 以及医院并发症或问题 (4)。百分之三十的 PCP 不知道患者住院。如果 PCP 不知道住院，患者报告问题的可能性是患者的两倍（31% PCP 知道，而 67% PCP 不知道；P < 0.05）。 结论：这项研究表明，许多体弱的老年患者在出院后报告问题，而当患者的 PCP 不知道住院时，报告问题的可能性是患者的两倍。需要采取系统干预措施来改善患者住院期间与 PCP 的沟通。医院医学杂志2010; 5：385-391。 (C) 2010 年医院医学学会。
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 frail, older general medical patients conducted 2 weeks after discharge to elicit patient problems after discharge, such as: (1) 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 2 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. Journal of Hospital Medicine 2010; 5: 385-391. (C) 2010 Society of Hospital Medicine.