Confusion reigns on best handover of patients from secondary to primary care

By Caroline Price, Senior medwireNews Reporter

Several planned interventions have reportedly improved the quality and safety of patient handovers between hospital and primary care, yet robust evidence of their benefits is still lacking, conclude researchers who conducted a systematic review of studies to date.

Such promising initiatives as Better Outcomes for Older adults through Safe Transitions (BOOST) and State Action on Avoidable Rehospitalizations (STAAR) have already been embraced as best practice by some hospitals.

However, such is the heterogeneity of the programs tested and the uncertainty over validity of outcomes measured, no conclusive evidence of their benefit is really available, say Gijs Hesselink (Radboud University Nijmegen Medical Centre, the Netherlands) and team.

The researchers looked at 36 relevant studies, most of which (70%) showed significant benefits of the interventions tested, for at least one outcome, and almost all of which (94%) involved multicomponent interventions.

Most efforts were aimed at improving coordination of care and communication between primary and secondary care providers and pharmacists, say Hesselink et al.

Discharge interventions that reduced hospital use (eg, rehospitalizations or emergency department use) were those aimed at improving continuity of care after discharge (eg, timeliness and accuracy of discharge information received by, or accessible to, the general practitioner) and patient status (quality of life and satisfaction).

Although there was no strong evidence that a specific single intervention was regularly associated with improvement in a specific outcome, the researchers did find links between strongly related intervention components and outcomes, such as medication reconciliation reducing the percentage of unreconciled medications after discharge.

"We believe that promising interventions for improving patient handovers exist but require further investigation," the authors conclude in the Annals of Internal Medicine.

In another review published in the same journal, Janet Prvu Bettger (Duke University, Durham, North Carolina, USA) and colleagues report that hospital-initiated support for discharge of patients to home or intermediate-care settings proved beneficial in terms of reduced hospital days after stroke, but less so after myocardial infarction (MI). There was insufficient evidence to draw conclusions about the other interventions tested for handover of stroke and MI patients.

"Although we may not yet know which specific interventions yield the most benefit, these two quality reviews of the current body of evidence about transitional care begin to identify important gaps in available research," comments Susan Bray-Hall (University of Colorado, Denver, USA) in an accompanying editorial.

"By providing a structure around which to examine transitions, these reviews help in the next important steps: identifying pertinent outcomes; clearly defining simple and reproducible interventions; assessing costs; choosing the appropriate target population for study; and, eventually, designing collaborative, multi-institutional studies to translate the most effective programs into wider practice."

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