Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada.
Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
BMC Fam Pract. 2021 Sep 7;22(1):176. doi: 10.1186/s12875-021-01524-7.
Patients with chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are at high-risk of readmission after hospital discharge. There is conflicting evidence however on whether timely follow-up with a primary care provider reduces that risk. The objective of this study is to understand the perspectives of patients with COPD and CHF, and their caregivers, on the role of primary care provider follow-up after hospital discharge.
A qualitative study design with semi-structured interviews was conducted among patients or their family caregivers admitted with COPD or CHF who were enrolled in a randomized controlled study at three acute care hospitals in Ontario, Canada. Participants were interviewed between December 2017 to January 2019, the majority discharged from hospital at least 30 days prior to their interview. Interviews were analyzed independently by three authors using a deductive directed content analysis, with the fourth author cross-comparing themes.
Interviews with 16 participants (eight patients and eight caregivers) revealed four main themes. First, participants valued visiting their primary care provider after discharge to build upon their longitudinal relationship. Second, primary care providers played a key role in coordinating care. Third, there were mixed views on the ideal time for follow-up, with many participants expressing a desire to delay follow-up to stabilize following their acute hospitalization. Fourth, the link between the post-discharge visit and preventing hospital readmissions was unclear to participants, who often self-triaged based on their symptoms when deciding on the need for emergency care.
Patients and caregivers valued in-person follow-up with their primary care provider following discharge from hospital because of the trust established through pre-existing longitudinal relationships. Our results suggest policy makers should focus on improving rates of primary care provider attachment and systems supporting informational continuity.
慢性阻塞性肺疾病（COPD）和充血性心力衰竭（CHF）患者在出院后再次入院的风险很高。然而，关于初级保健提供者的及时随访是否降低了这种风险，目前还存在相互矛盾的证据。本研究的目的是了解 COPD 和 CHF 患者及其护理人员对出院后初级保健提供者随访作用的看法。
采用半结构式访谈的定性研究设计，对加拿大安大略省三家急性护理医院随机对照研究中入院的 COPD 或 CHF 患者或其家属进行了访谈。参与者的访谈时间在 2017 年 12 月至 2019 年 1 月之间，大多数人在访谈前至少 30 天出院。三位作者独立使用演绎定向内容分析法分析访谈，第四位作者交叉比较主题。
对 16 名参与者（8 名患者和 8 名护理人员）的访谈揭示了四个主要主题。首先，参与者重视在出院后就诊他们的初级保健提供者，以建立他们的纵向关系。其次，初级保健提供者在协调护理方面发挥了关键作用。第三，对随访的理想时间存在不同看法，许多参与者表示希望推迟随访，以在急性住院后稳定病情。第四，参与者对出院后就诊与预防住院再入院之间的联系并不清楚，他们通常根据自己的症状进行自我分诊，决定是否需要紧急护理。
患者和护理人员重视在出院后与他们的初级保健提供者进行面对面的随访，因为这是通过预先建立的纵向关系建立起来的信任。我们的研究结果表明，政策制定者应重点关注提高初级保健提供者的就诊率和支持信息连续性的系统。
