PATIENT FOLLOW-UP AND READMISSIONS IN 2 MAJOR HEALTH INSTITUTIONS OF FAKO DIVISION SOUTH WEST REGION, CAMEROON.

Abstract

Brief background: Patient follow-up, the constellation of future activities like return visits etc. by a patient after hospitalisation or therapy, intends to help return the patient’s health conditions to a desired state of health. It is a major way to continue care even after patients have left the hospital premises and by keeping in touch with the patient more information regarding their health is unveiled.

Some major countries of the world have taken measures to put in place strategies that enhance continuity of care which includes patient follow-up after a discharge or a check-up. Its importance is in record but not fully displayed in the practice as little literature has been discussed in our setting.

Main objective: This study was carried out to explore patient follow-up in 2 major hospitals in the Fako division, South West (SW), Cameroon, (Cmr). These hospitals include the Buea Regional Hospital (BRH) and the Tiko Cottage Hospital (TCH).

We sought to describe by this study patient follow-up rates, hospital readmissions rates, knowledge of health practitioners on patient follow-up and the hindrances to patient follow-up.

Methodology: It was an observational, cohort, hospital-based descriptive study at the Buea Regional Hospital and Tiko Cottage Hospital of the Southwest Region for a period of three months, January 2015 to March 2015.

According to our inclusion criteria, a random sampling method was used both for patient follow-up rate and readmission rate to seek out patients’ discharged files.

Findings:  There are no records on follow-up either through calls or home visits. Following discharge from these two hospitals, only 3.2% of patients are given a documented rendezvous. The Buea Regional Hospital records a 5.7% readmission rate for both male and female medical wards, while the Tiko Cottage hospital a readmission rate of 3%.

Conclusion: Early evaluation after discharge is critical and thus any evaluation done should include a review of therapeutic changes out of the highly structured hospital. Also preventing hospital readmissions has the potential to profoundly improve the quality of life for patients.

CHAPTER ONE

INTRODUCTION

1.1 Background

Patient follow-up is defined by the MacGraw-Hill concise dictionary of modern medicine as the constellation of future activities, for instance return visits by a patient after hospitalization or therapy, intended to help in return to a desired state of health [1].

Katie et al, defines it as a vital part of on-going patient safety which allows for subsequent investigations to be checked and acted upon as well as encourages specialist review of patients thereby ensuring that patients with chronic conditions receive appropriate secondary care [2].

Some patients upon return to the house do return with their unfinished medications as seen from our hospitals here in the southwest, while others are prescribed some to purchase later in pharmacies.

Depending on the quantity of the different medications to be taken, the likelihood of an adverse event may increase in patients using more than five medications. One of these adverse effects is taking medications the wrong way i.e. either an overdose or an underdose.

These errors mostly occur when patients are discharged but whatever the case; it is shown that an effective way to reduce such an adverse event is through patient follow-up post-discharge by the means of follow-up telephone calls [3].

Also, readmission is believed to have a major role in the reduction of the quality of life as well as to increase expenditure on health [4]. It is suggested, as evidence proves, that patient follow-up post-discharge is beneficial both in reducing medication errors in patients who may forget the said prescriptions and also in reducing hospital readmission [3].

Some major countries of the world have taken measures to put in place strategies that enhance continuity of care which includes patient follow-up after a discharge or a check-up [5]. In other words, it could be home visits or return visits as part of patient follow-up.

Its importance is in the record, we find it in textbooks or other literature sources but the evidence of its practice is not certain in our setting. In this study, we explored its occurrence and came out with its implications on the patient and the health care system as a whole.

The information contained within this piece of work draws from a variety of sources of which include published protocols and unpublished literature gotten from the internet.

1.2 Problem Statement

Several studies have shown that adverse events during the post-hospitalization period occur in approximately one in five patients [6], [7]. When patients are discharged the period following their hospitalization remains a particularly vulnerable time for them [8].

Most adverse events occur during this post-discharge period and patients could be especially vulnerable during this period because they still have functional impairments. This vulnerability may also be worsened by the patient’s home environment after leaving the hospital [6], [7].

Despite the importance of follow-up during this vulnerable period following discharge, there has been little research addressing it and little attention has been paid to it in the literature [9].

1.3 Rationale

According to Eric et al (2010), follow-up visits post-discharge presents a critical opportunity to address the conditions that precipitated the hospitalization and to prepare the patient and family caregiver for self-care activities [9].

Recently, national development policies, in the developed world, aimed at aligning financial incentives to reduce preventable hospital readmissions have greater focus on post-hospital ambulatory visits [9].

For instance, newly enacted health reform laws promote bundled payment approaches, among others, for services furnished by an appropriate physician who sees an individual within the first week after discharge from a hospital [9].

In addition, the physician’s accountability in managing transitions between inpatient and outpatient settings is addressed by the recommended principles and standards of the Transitions of Care Consensus Policy Statement jointly endorsed by six physician societies [9].

All these initiatives are based on the assumption that primary care practices are both well positioned and well prepared to intervene in the cycle of hospital readmission [9]. From previous studies, the rate of readmission is likely to reduce if measures such as telephone calls are implemented which is an aspect of patient follow-up [10].

Little is known about how much has been done to enhance continuity of care (follow-up post discharge) by applying such basic principles in our setting.

This study was carried out to learn more about rehospitalization and the frequency of follow-up outpatient visits post-discharge.  the reason for our study is to explore; the number of patients given a rendezvous, RDV, in other words, a follow-up RDV, hospital readmission rates in these two hospitals, the knowledge of health practitioners (HPs) on patient follow-up, and the hindrances to patient follow-up.

1.4 Research Goal

To improve the quality of patient care and patient satisfaction in the Southwest Region and Cameroon by describing patient follow-up and implications in our setting based on the findings of these two hospitals.

1.5 Research Objectives

1. To assess the follow-up rate post-discharge in these two major hospitals of the South West Region.
2. To determine the rate of hospital readmission.
3. To describe the knowledge health practitioners on patient follow-up.
4. To describe the hindrances to proper patient follow-up following discharge from the hospital.

1.6 Research Questions

1. What is the follow-up rate of patients following a discharge at the Buea Regional Hospital (BRH) and Tiko Cottage Hospital (TCH)?
2. What is the hospital readmission rate in these three hospitals?
3. What is the knowledge of health practitioners on patient follow-up?
4. Are there hindrances to patient follow-up?