Follow-up Study, Medical In-patients
Conditions
Keywords
medical in-patients, follow-up care, developing country
Brief summary
The post discharge time is a vulnerable time for general medical in-patients, with high rates of adverse events that may cause unnecessary readmissions and even death. A recent study of 415 patients discharged from the general medical wards at Groote Schuur Hospital, demonstrated a very high 12 month mortality of 35%. The majority of these deaths were classified as unexpected. The reasons for this were not further examined, but it was speculated, given the authors' knowledge of the public sector in Cape Town, that three related factors contribute significantly to this early mortality: i) a lack of continuity of care, with patients not necessarily accessing the primary care support treatment that they need or being able to access early post discharge follow-up (for example for anti-retroviral or anti-tuberculous care); ii) the inability of primary care to deal with the complex nature of the discharged patients, most whom have significant co-morbid disease; iii) A lack of optimisation of therapy for chronic disease after acute discharge. The investigators hypothesise that an integrated post-discharge transitional care package, which includes an early medical specialist follow-up in the first 3 months after hospital discharge will decrease the 6- and 12-month mortality and re-admission rate amongst general medical hospital admissions in Cape Town, South Africa. Our study will compare an integrated package, suitable to implementation if effective, with current standard discharge packages.
Interventions
OTHERIntegrated medical follow-up package
At discharge, patients will receive a discharge plan by their attending caregiver. 1. On day 3 they will be contacted telephonically to: i) Discuss their discharge diagnosis and medications ii) Arrange specialist clinic follow-up booking for 2 weeks iii) Reemphasise drug compliance 2. Reminders via SMS to attend there OPD appointment(s) 3. Medical out-patient review at 2-weeks and 6 weeks if required 4. Medical telephonic hot-line for advice
Sponsors
University of Cape Town
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Caregiver)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Patients referred for admission to general medical wards (including within hospital transfer e.g. ICU discharge) 2. \>18 years and willing to give informed consent
Exclusion criteria
1. Patient admitted directly to intensive care unit 2. Patient refusing consent or \<18 years old 3. Patients electively admitted 4. Patients without phone numbers who cannot provide any telephone contact details for a co-habitant, relative or neighbour.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| All cause mortality | 12 months | All cause 12-month mortality will be evaluated at 12-months post enrolment. Data on mortality will be acquired through telephonic patient/family contact and review of provincial death registry |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| All cause mortality | 6 months | 6-month mortality will be evaluated in a similar way to 12-month mortality. |
| Hospital readmission rate | 12 months | Readmission to secondary, tertiary hospitals or emergency units will be included. |
| Bartel index | 12 months | The change in functional outcome between discharge and 12-months will be measured using the Bartel index. |
| Karnofsky performance score | 12 months | Changes in functional outcomes will be assessed by measuring the change in Karnofsky performance scores between 12-months and pre-admission. |
Countries
South Africa
Outcome results
None listed