Impact of Medical Follow-up Discharge Package

NCT ID: NCT01916876

Last Updated: 2014-12-03

Basic Information

• Recruitment Status: WITHDRAWN
• Clinical Phase: NA
• Study Classification: INTERVENTIONAL
• Study Start Date: 2015-03-31
• Study Completion Date: 2016-05-31

Brief Summary

The post discharge time is a vulnerable time for general medical in-patients, with high rates of adverse events that may cause unnecessary readmissions and even death. A recent study of 415 patients discharged from the general medical wards at Groote Schuur Hospital, demonstrated a very high 12 month mortality of 35%. The majority of these deaths were classified as "unexpected". The reasons for this were not further examined, but it was speculated, given the authors' knowledge of the public sector in Cape Town, that three related factors contribute significantly to this early mortality: i) a lack of continuity of care, with patients not necessarily accessing the primary care support treatment that they need or being able to access early post discharge follow-up (for example for anti-retroviral or anti-tuberculous care); ii) the inability of primary care to deal with the complex nature of the discharged patients, most whom have significant co-morbid disease; iii) A lack of optimisation of therapy for chronic disease after acute discharge.

The investigators hypothesise that an integrated post-discharge transitional care package, which includes an early medical specialist follow-up in the first 3 months after hospital discharge will decrease the 6- and 12-month mortality and re-admission rate amongst general medical hospital admissions in Cape Town, South Africa. Our study will compare an integrated package, suitable to implementation if effective, with current standard discharge packages.

Conditions

Follow-up Study; Medical In-patients

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: SINGLE

Study Groups

Standard Care

At discharge, patients will be given a discharge plan by their attending caregiver as deemed appropriate.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Integrative medical follow-up package

At discharge, patients will receive a discharge plan by their attending caregiver.

Thereafter, if randomised to this study arm they will receive the intervention as outlined elsewhere.

"Integrated Medical Follow-up package"

Group Type: OTHER

Integrated medical follow-up package

Intervention Type: OTHER

At discharge, patients will receive a discharge plan by their attending caregiver.

1. On day 3 they will be contacted telephonically to:

i) Discuss their discharge diagnosis and medications ii) Arrange specialist clinic follow-up booking for 2 weeks iii) Reemphasise drug compliance

2. Reminders via SMS to attend there OPD appointment(s)

3. Medical out-patient review at 2-weeks and 6 weeks if required

4. Medical telephonic "hot-line" for advice

Interventions

Integrated medical follow-up package

At discharge, patients will receive a discharge plan by their attending caregiver.

1. On day 3 they will be contacted telephonically to:

i) Discuss their discharge diagnosis and medications ii) Arrange specialist clinic follow-up booking for 2 weeks iii) Reemphasise drug compliance

2. Reminders via SMS to attend there OPD appointment(s)

3. Medical out-patient review at 2-weeks and 6 weeks if required

4. Medical telephonic "hot-line" for advice

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

1. Patients referred for admission to general medical wards (including within hospital transfer e.g. ICU discharge)

2. >18 years and willing to give informed consent

Exclusion Criteria

1. Patient admitted directly to intensive care unit

2. Patient refusing consent or <18 years old

3. Patients electively admitted

4. Patients without phone numbers who cannot provide any telephone contact details for a co-habitant, relative or neighbour.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of Cape Town

OTHER

Sponsor Role: lead

Responsible Party

Jonathan Peter

Honorary Consultant, Department of Medicine

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Jonathan Peter

Role: PRINCIPAL_INVESTIGATOR

University of Cape Town

Locations

Groote Schuur Hospital

Cape Town, , South Africa

Victoria Hospital

Cape Town, , South Africa

Countries

South Africa

References

Stuart-Clark H, Vorajee N, Zuma S, Van Niekerk L, Burch V, Raubenheimer P, Peter JG. Twelve-month outcomes of patients admitted to the acute general medical service at Groote Schuur Hospital. S Afr Med J. 2012 May 23;102(6):549-53. doi: 10.7196/samj.5615.

Reference Type: BACKGROUND

PMID: 22668961 (View on PubMed)

Other Identifiers

UCT 148.2/2013

Identifier Type: -

Identifier Source: org_study_id