Communication between patients and primary care providers after discharge from hospital - a scoping review

Problem

Care transitions from secondary to primary care are a potentially risky part of the patient journey, particularly for older patients with multi-morbidity and polypharmacy. Our recent work shows that management in primary care after discharge from hospital causes harm to 8% of this vulnerable group of patients. Communication problems between patients and primary care providers are at the heart of many errors and subsequent harms which occur. Improved communication might also be a strategy to reduce the 22.8% rise seen in emergency re admissions between 2012 and 2016. There are 3 participants in the communication triangle at care transition (patients, primary care providers and secondary care providers) and yet most current literature focuses on the latter two.

Approach

In order to address this communication deficit we plan to develop a tool which will help older patients and their carers communicate with their primary care provider after discharge. In order to begin a co-production process to create this tool a systematized review is being conducted to inform the possible content of this tool. We used three search stems relating to: 1-Primary care or transitional care setting, 2-Discharge events and 3-faciliation of communication. We deliberately did not limit our findings to the older patient population (in order not to miss any transferable literature). The review uses a dual reviewer system and adheres to best principles described by Cochrane for systematic reviewing but due to the nature of the research questions is essentially a scoping review.

Findings

The review is in progress and will be reported in early 2020. We searched 5 databases which included (CINAHL, Cochrane, Embase, MEdline, Web of Science) on 7/10/19 with no limitations in terms of language or date of publication. 716 titles were considered after removal of duplicates. From these 227 abstracts were selected. We anticipate that around 90 papers will meet the criteria for full review and these papers will be quality assessed prior to extraction of transferable content.

Consequences

The findings from the review will be used to inform the creation of a unique intervention to improve patient’s communication with their primary care provider after discharge from hospital. Improving health efficacy is a key, and as yet, under-explored strategy to make care transitions safer for older patients. This work represents the very beginning of a programme of work which seeks to give patients a stronger voice as the 3rd point of the triangle of care transition communication.