Impact of Medical Follow-up Discharge Package

Not Applicable

Withdrawn

• Conditions: Follow-up Study; Medical In-patients
• Interventions: Other: Integrated medical follow-up package

• Registration Number: NCT01916876
• Lead Sponsor: University of Cape Town

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.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2013-08-01
• Study First Submitted QC: 2013-08-05
• Study First Posted: 2013-08-06
• Status Verified: 2014-12
• Last Update Submitted: 2014-12-02
• Last Update Posted: 2014-12-03
• Study Start: 2015-03
• Primary Completion: 2015-12
• Study Completion: 2016-05

Recruitment & Eligibility

• Status: WITHDRAWN
• Sex: All
• Target Recruitment: Not specified

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.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Integrative medical follow-up package	Integrated 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"

Primary Outcome Measures

Name	Time	Method
All cause mortality	12 months	All cause 12-month mortality will be evaluated at 12-months post enrolment. Data on mortality will be acquired through telephonic patient/family contact and review of provincial death registry

Secondary Outcome Measures

Name	Time	Method
All cause mortality	6 months	6-month mortality will be evaluated in a similar way to 12-month mortality.
Hospital readmission rate	12 months	Readmission to secondary, tertiary hospitals or emergency units will be included.
Bartel index	12 months	The change in functional outcome between discharge and 12-months will be measured using the Bartel index.
Karnofsky performance score	12 months	Changes in functional outcomes will be assessed by measuring the change in Karnofsky performance scores between 12-months and pre-admission.

Trial Locations

Locations (2)

Victoria Hospital; 🇿🇦 Cape Town, South Africa

Groote Schuur Hospital; 🇿🇦 Cape Town, South Africa