Telephone follow-up initiated by a hospital-based health professional for postdischarge problems in patients discharged from hospital to home.

OBJECTIVES: To determine the effects of follow-up telephone calls (TFU) in the first month post discharge, initiated by hospital-based health professionals, to patients discharged from hospital to home, with regard to physical and psycho-social outcomes in the first three months post discharge. The effects of TFU will be compared to usual care or other types of hospital follow-up (e.g. TFU initiated by primary-care-based health professionals). The effects of TFU initiated/delivered by various health care professionals (e.g. nurse, MD, social worker, pharmacist, ...) will be assessed in subgroup analyses. Although we expect to find that most TFU interventions will focus on outcomes such as reassurance and informational needs, we will include other types of outcomes because of the great variety of postdischarge problems. THE FOLLOWING QUESTIONS WILL BE ADRESSED: Primary Outcomes:
What are the effects of TFU initiated by a hospital-based health professional, on the psycho-social health (uncertainty, anxiety, informational needs, mood, perceptions of coping, quality of life, social activity) of patients in the first three months post discharge, compared to usual care or other types of hospital follow-up?; What are the effects of TFU on the physical health (activities of daily living, self-care abilities, self efficacy, independence) of patients in the first three months post discharge compared to usual care or other types of hospital follow-up?. Secondary Outcomes:
What are the effects of TFU on adherence of patients to recommended care in the first three months post discharge compared to usual care or other types of hospital follow-up?; What are the effects of TFU on patient knowledge regarding disease or symptom management in the first three months post discharge compared to usual care or other types of hospital follow-up?; What are the effects of TFU on adverse events (new morbidity, readmission) in the first three months post discharge compared to usual care or other types of hospital follow-up?; What are the effects of TFU on service utilization (health care services) in the first three months post discharge compared to usual care or other types of hospital follow-up? FACTORS INFLUENCING OUTCOMES: Intervention-related factors: Does the structure/format of the TFU influence the outcomes?; Does the type of health care provider (e.g. doctor, nurse, social worker, ...) of the TFU influence the outcomes?; Does the timing of the TFU influence the outcomes?; Does the frequency of the TFU influence the outcomes?; Do discharge planning activities and/or aftercare interventions other than the TFU influence the outcomes?. Patient-related factors: Does the age of patients influence the effects of TFU?;
Does the length of hospital stay influence the effects of TFU?; Does the medical diagnosis or procedure, carried out prior to discharge, influence the effects of TFU?; Do disease severity and co-morbidities influence the effects of TFU?;
Does the person's home living arrangements (living alone, living with someone) influence the effects of TFU?; Does the gender of patients influence the effects of TFU?. Other related factors: Does the country influence the effects of TFU?;
Does the type of hospital influence the effects of TFU?; Note: throughout this protocol the term 'patient' is used; although we recognize that terms such as 'consumer', 'client', or 'person with ... condition' may be more accurate than 'patient' and preferred by consumers themselves, we think that 'patient' remains the term that is most well known internationally to denote a person that is or has been in contact with a health professional for a certain condition.
CRITERIA FOR CONSIDERING STUDIEDS FOR THIS REVIEW: Types of studies: randomised controlled trials;
controlled trials. Types of participants: all patients discharged from an acute hospital setting (including emergency departments and one-day-stay procedures) to home (including a relative's home but excluding nursing homes or convalescence homes); all ages. Types of intervention: Experimental intervention: Telephone follow-up (TFU) initiated by a hospital-based health professional (medical, nursing, social work, pharmaceutical, (...) to a patient who is discharged to his/her own home setting (including a relative's home). The TFU has to be performed at least once within the first month after discharge. The TFU may have any kind of structure: for instance completely open ('how are you doing?') or completely structured. The TFU may contain one or more elements such as gathering of information, giving reassurance, giving advice on several topics, counseling, referral where required, etc. The TFU has, in principle, to be targeted to the patients themselves. In cases where the patients themselves are not able to talk on the phone (e.g. very young children, very sick people, patients with severe Alzheimer's disease) on one or more occasions when the TFU is delivered, these studies will be included. On the data-extraction sheet we will note the extent to which the TFU was indirect, and we will conduct separate analyses for studies in which the intervention for the entire research population was delivered directly to the patients, and for studies in which the TFU was (partly) delivered to relatives/caregivers. Studies in which the TFU is intended primarily to address the problems of caregivers rather than of patients, will be excluded. The TFU may be delivered as the only aftercare intervention, or may be part of a multi-component discharge planning or aftercare intervention; Control intervention: Usual care or other types of hospital follow-up.
TYPES OF OUTCOME MEASURES: Psycho-social health of patients: 1. uncertainty; 2. anxiety; 3. informational needs;
4. mood; 5. coping; 6. quality of life; 7. social activity. Physical health of patients: 8. level of activities of daily living (ADL)/functional status; 9. self-care abilities; 10. self efficacy; 11. independence. Other consumer oriented outcomes:
12. treatment adherence; 13. knowledge of disease and symptom management; 14. adverse events (complications, infection, readmission). Health service delivery oriented outcomes: 15. hospital readmission; 16. health services utilization. The outcomes must be measured at least once within the first three months post discharge. Since there is no generally-accepted definition of what a postdischarge period means, and the duration of postdischarge problems may vary for different illnesses and treatment procedures, the choice of a time period for study must be arbitrary. However there is evidence, as stated earlier, that most postdischarge problems occur in the period immediately after discharge. Moreover three months is a period for which it is reasonable to assume that outcomes can be related to the intervention in the first month after discharge; it is not likely that if no-effect were found in this immediate postdischarge time frame, effects would be found later . No restrictions will be made with regard to the measurement tools used, but psychometric properties will be recorded. This review will be limited to outcomes in patients themselves; possible outcomes in carers or
relatives will not be included. (aut. ref.)