Real-life implementation of guidelines on the hospital-to-home transition for older patients: a cohort study in general practice

• Published in: Age and ageing Vol. 49; no. 1; pp. 46 - 51
• Main Authors: Hurtaud, Aline, Lallier, François, Heidet, Matthieu, Arnoult, Charline, Dramé, Moustapha, Canouï-Poitrine, Florence
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.01.2020; Oxford Publishing Limited (England); Oxford University Press (OUP)
• Subjects: Cognitive ability; Cognitive impairment; Cohort analysis; Compliance; Discharge summaries; Family physicians; Feasibility; General practice; Independent living; Life Sciences; Males; Patients; Primary care; Readmission; Santé publique et épidémiologie; aged; patient readmission; older people; continuity of patient care; patient discharge; general practice
• ISSN: 0002-0729; 1468-2834; 1468-2834
• DOI: 10.1093/ageing/afz143

Abstract Background hospital discharge is a critical event for older patients. The French guidelines recommended the swift transmission of a discharge summary to the general practitioner (GP) and a primary care consultation within 7 days. The relevance and feasibility of these guidelines have not previously been assessed. Objective to perform a real-life assessment of compliance with French guidelines on the transmission of discharge summaries and post-discharge medical reviews and to examine these factors’ association with 30-day readmissions. Design a prospective multicentre cohort study. Setting primary care (general practice) in France. Subjects a sample of GPs and the same number of patients aged 75 or over having consulted within 30 days of hospital discharge. Methods the main endpoints were the proportion of discharge summaries available and the proportion of patients consulting their GP within 7 days. The 30-day readmission rate was also measured. Factors associated with these endpoints were assessed in univariate and multivariate analyses. Results seventy-one GPs (mean ± standard deviation age: 49 ± 11; males: 62%) and 71 patients (mean age: 84 ± 5; males: 52%; living at home: 94%; cognitive disorders: 22%) were included. Forty-six patients (65%, [95% confidence interval [CI]]: 53–76) consulted their GP within 7 days of hospital discharge. At the time of the consultation, 27 GPs (38% [95% CI]: 27–50) had not received the corresponding hospital discharge summary. Discharge summary availability was associated with a lower risk of 30-day readmission (adjusted odds ratio [95% CI] = 0.25 [0.07–0.91]). Conclusions compliance with the French guidelines on hospital-to-home transitions is insufficient.