Background: The transition from hospital to home is high risk period for the patients. The role of general practitioner (GP) and communication with him are critical in early follow-up after discharge. We empirically observed, in our internal medicine department, that only 20% of patients have a follow-up visit within 30 days. Data to understand this low rate are missing, although GP follow-up should prevent early readmission. Insights about underlying causes would help to improve the transition of care.
Objectives: We aimed to evaluate the rate and timing of GP follow-up within 30 days after hospital discharge. We also aimed to assess characteristics of patients and association with follow-up appointment and define potentially modifiable factors.
Methods: We conduct a prospective observational study in the internal medicine department in the
University Hospital of Lausanne (CHUV), Switzerland. We collected socio-demographic data,
diagnosis, and medical history by structured phone call interviews and from medical records. The
:
occurrence of follow-up visit was confirmed by phone calls to the GP. We used a multivariable analysis to determine the link between medico-social characteristics and follow-up visit.
Results: We included 119 consecutive patients. The follow-up visit rate within 30 days was 60%. On average, follow-up visit occurred 14 days after discharge. GP with internal general medicine specialization were associated with more follow-up visits (OR 5.24, P<0.009) than other specialization.
Conclusion: The participation rate was significantly higher than previously found. Potentially modifiable factors were: the specialty of the doctor performing the follow-up, the information given to the patient during discharge and the availability of natural caregivers for patient transportation. Further interventions and studies should focus on how to act upon these factors, how to reduce the time before the follow-up visit and improve the communication with patient during the discharge process.