Investigating clinical handover and healthcare communication for outpatients with chronic disease in India: A mixed-methods study

Research output: Contribution to journalArticlepeer-review

Authors

  • Claire Humphries
  • Suganthi Jaganathan
  • Jeemon Panniyammakal
  • Sanjeev Singh
  • Shifalika Goenka
  • Prabhakaran Dorairaj
  • Paramjit Gill
  • Richard Lilford

Colleges, School and Institutes

External organisations

  • Keele University
  • Centre for Chronic Disease Control, New Delhi, Delhi, India.
  • Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India.
  • Hospital Administration, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
  • The University of Warwick
  • Division of Health Sciences, Warwick - Centre for Applied Health Research and Delivery (WCAHRD), Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom.

Abstract

OBJECTIVES: Research concentrating on continuity of care for chronic, non-communicable disease (NCD) patients in resource-constrained settings is currently limited and focusses on inpatients. Outpatient care requires attention as this is where NCD patients often seek treatment and optimal handover of information is essential. We investigated handover, healthcare communication and barriers to continuity of care for chronic NCD outpatients in India. We also explored potential interventions for improving storage and exchange of healthcare information.

METHODS: A mixed-methods design was used across five healthcare facilities in Kerala and Himachal Pradesh states. Questionnaires from 513 outpatients with cardiovascular disease, chronic respiratory disease, or diabetes covered the form and comprehensiveness of information exchange between healthcare professionals (HCPs) and between HCPs and patients. Semi-structured interviews with outpatients and HCPs explored handover, healthcare communication and intervention ideas. Barriers to continuity of care were identified through triangulation of all data sources.

RESULTS: Almost half (46%) of patients self-referred to hospital outpatient clinics (OPCs). Patient-held healthcare information was often poorly recorded on unstructured sheets of paper; 24% of OPC documents contained the following: diagnosis, medication, long-term care and follow-up information. Just 55% of patients recalled receiving verbal follow-up and medication instructions during OPC appointments. Qualitative themes included patient preference for hospital visits, system factors, inconsistent doctor-patient communication and attitudes towards medical documents. Barriers were hospital time constraints, inconsistent referral practices and absences of OPC medical record-keeping, structured patient-held medical documents and clinical handover training. Patients and HCPs were in favour of the introduction of patient-held booklets for storing and transporting medical documents.

CONCLUSIONS: Deficiencies in communicative practices are compromising the continuity of chronic NCD outpatient care. Targeted systems-based interventions are urgently required to improve information provision and exchange. Our findings indicate that well-designed patient-held booklets are likely to be an acceptable, affordable and effective part of the solution.

Details

Original languageEnglish
Article numbere0207511
JournalPLoS ONE
Volume13
Issue number12
Publication statusPublished - 5 Dec 2018