General Practitioner Follow-up Research Articles

Abstract 4126893: Feasibility and Acceptability of a Nurse-Pharmacist Post-Discharge Telehealth Model of Care for Heart Failure Patients

Background: Suboptimal medication management is common in patients with heart failure (HF), particularly during transitions-of-care. To date, there are few studies assessing the feasibility of a nurse-pharmacist post-discharge telehealth service for medication optimisation in patients with HF. We performed a feasibility study to determine service uptake and acceptability, and ability to identify medication-related issues for HF patients as they transition from hospital to home. Methods: HF patients were referred to an existing post-discharge telehealth service and offered medication reconciliation and education in addition to their usual care; a service we termed ‘MedRec’ (MR). Primary outcomes were feasibility, measured through recruitment and successful MR completion, and acceptability, measured by an investigator-developed survey. Secondary outcomes were medication-related issues detected during MR. Results: A total of 100 HF patients were offered a post-discharge MR. Mean age of patients was 68.5 ±14.2 years, and mostly male sex (62%). Pharmacist MRs were requested by 80% of patients. In total 62 MRs (77.5%) were performed; 9 patients declined MR during follow-up and an additional 9 patients were uncontactable. Mean time to MR following nurse referral was 10.98 ±9.74 days. Drug-related toxicity or adverse effect presentation was identified in 25 (40.3%) MR recipients at the time of consultation and subsequently required general practitioner follow-up. Medication compliance issues were detected by the pharmacist in 13 (20.9%) patients; forgotten doses being the most common concern. Undertreated medical conditions, such as symptomatic HF and chronic pain, were identified in 12 (19.3%) MR recipients. Medications prescribed without any apparent indication were found in 8 (12.9%) patients. Drug or disease management information was requested by 35 (56.4%) MR recipients. A total of 35 (56.5%) post-MR surveys were successfully completed. All participants who completed a post-MR survey agreed that a post-discharge telehealth MR was an acceptable form of education provision. Engagement with a pharmacist MR was perceived to ease anxiety associated with understanding medication-related changes and empowered greater medication self-management. Conclusions: A post-discharge nurse-pharmacist telehealth service is a feasible and acceptable model of care. Inclusion of a routine MR post-discharge may be an effective means of maintaining continuity of care for HF patients.

Screening, investigation and follow-up of neonates with small for gestational age in a metropolitan hospital in Australia-observational retrospective study.

Infants with small for gestational age (SGA) have an increased risk of short and long-term health outcomes, with potentially modifiable risk factors. This study aims to determine the prenatal risk factors associated SGA and evaluate the clinical management of affected infants. An observational retrospective study of medical records of infants born at Nepean Hospital and discharged with a diagnosis of SGA over 5 years (1st January 2015 to 31st December 2019). Data included demographic details, antenatal care, maternal risk factors and clinical management of the infants. Six hundred and seven infants had a discharge diagnosis of SGA, from 20,392 infants born. Of the 607 infants identified, 487 (80%) had SGA, 97 (16%) had asymmetrical SGA, 175 (29%) had symmetrical SGA, and 50 (8%) were incorrectly diagnosed with SGA based on growth measurements taken at birth. The most prevalent maternal risk factors were the presence of chronic disease (n=402, 66.23%), current smoking (n=159, 26.19%), social work input (n=108, 17.79%), gestational diabetes mellitus (n=96, 15.82%) and Aboriginal background (n=73, 12.03%). Prenatal genetic testing was conducted in 89.62% (n=544); 58.81% (n=357) had placental abnormalities; 36.57% (n=222) were recommended follow-up with a general practitioner (GP) and paediatrician, and 21.09% (n=128) were recommended a combination of midwifery in the home (MITH), GP, and paediatric follow-up. Two infants were recorded with no follow-up. Diagnostic inaccuracies were found in infants with SGA. More intensive antenatal care for women with risk factors for SGA might improve the health of those with chronic disease; support for smoking cessation could also be offered.

Risk of readmission and death after hospitalization for worsening heart failure: Role of post-discharge follow-up visits in a real-world study from the Grand Est Region of France.

Patients who experience hospitalizations due to heart failure (HF) face a significant risk of readmission and mortality. Our objective was to evaluate whether the risk of hospitalization and mortality following discharge from HF hospitalization differed based on adherence to the outpatient follow-up (FU) protocol comprising an appointment with a general practitioner (GP) within 15 days, a cardiologist within 2 months or both (termed combined FU). We studied all adults admitted for a first HF hospitalization from 2016 to 2020 in France's Grand Est region. Association between adherence to outpatient FU and outcomes were assessed with time-dependent survival analysis model. Among 67 476 admitted patients (mean age 80.3 ± 11.3 years, 53% women), 62 156 patients (92.2%) were discharged alive and followed for 723 (317-1276) days. Combined FU within 2 months was used in 21.1% of patients, with lower rates among >85 years, women, and those with higher comorbidity levels (p < 0.0001 for all). Combined FU was associated with a lower 1-year death or rehospitalization (adjusted hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.88-0.94, p < 0.0001) mostly related to lower mortality (adjusted HR 0.65, 95% CI 0.62-0.68, p < 0.0001) whereas HF readmission was higher (adjusted HR 1.19, 95% CI 1.15-1.24, p < 0.0001). When analysing components of combined FU separately, 1-year mortality was more related to cardiologist FU (HR 0.65, 95% CI 0.62-0.67, p < 0.0001), than GP FU (HR 0.87, 95% CI 0.85-0.90, p < 0.0001). Combined FU is carried out in a minority of patients following HF hospitalization, yet it is linked to a substantial reduction in 1-year mortality, albeit at the expense of an increase in HF hospitalizations.

SCORE: a randomised controlled trial evaluating shared care (general practitioner and oncologist) follow-up compared to usual oncologist follow-up for survivors of colorectal cancer

SCORE: a randomised controlled trial evaluating shared care (general practitioner and oncologist) follow-up compared to usual oncologist follow-up for survivors of colorectal cancer

Risk factors for hospital outcomes in pulmonary embolism: A retrospective cohort study.

Pulmonary embolism (PE) is not only a life-threatening disease but also a public health issue with significant economic burden. The aim of the study was to identify factors-including the role of primary care-that predict length of hospital stay (LOHS), mortality and re-hospitalization within 6 months of patients admitted for PE. A retrospective cohort study was conducted with patients presenting to a Swiss public hospital with PE diagnosed at the hospital between November 2018 and October 2020. Multivariable logistic and zero-truncated negative binomial regression analyses were performed to assess risk factors for mortality, re-hospitalization and LOHS. Primary care variables encompassed whether patients were sent by their general practitioner (GP) to the emergency department and whether a GP follow-up assessment after discharge was recommended. Further analyzed variables were pulmonary embolism severity index (PESI) score, laboratory values, comorbidities, and medical history. A total of 248 patients were analyzed (median 73 years and 51.6% females). On average patients were hospitalized for 5 days (IQR 3-8). Altogether, 5.6% of these patients died in hospital, and 1.6% died within 30 days (all-cause mortality), 21.8% were re-hospitalized within 6 months. In addition to high PESI scores, we detected that, patients with an elevated serum troponin, as well as with diabetes had a significantly longer hospital stay. Significant risk factors for mortality were elevated NT-proBNP and PESI scores. Further, high PESI score and LOHS were associated with re-hospitalization within 6 months. PE patients who were sent to the emergency department by their GPs did not show improved outcomes. Follow-up with GPs did not have a significant effect on re-hospitalization. Defining the factors that are associated with LOHS in patients with PE has clinical implications and may help clinicians to allocate adequate resources in the management of these patients. Serum troponin and diabetes in addition to PESI score might be of prognostic use for LOHS. In this single-center cohort study, PESI score was not only a valid predictive tool for mortality but also for long-term outcomes such as re-hospitalization within 6 months.

The first consultation for low mood in general practice: what do patients find helpful?

Recent evidence suggests that the first consultation with a general practitioner (GP) for symptoms of depression may be more than just a vehicle for assessment and management planning (as current guidelines imply). To identify what patients find helpful, or otherwise, in their first consultation for low mood with a GP. A cross-sectional questionnaire and interview study of patients with low mood who had recently consulted their GP, in the North of England. Patients were asked to complete a questionnaire regarding the consultation, and a Patient Health Questionnaire-9 (PHQ-9), within 2 weeks. They were also invited to take part in a face-face interview with a researcher. Both sources of data were subjected to qualitative thematic analysis. Thirty-seven questionnaires were returned; 5 interviews took place. The majority of participants felt better after consulting a GP for the first time for low mood. The factors most commonly cited as helpful were "being listened to" and "understanding or empathy from the GP." Others included "admitting the problem," "being reassured of normality," and "being provided with optimism or hope for change." The most commonly reported difficulty was the patients' struggle to express themselves. Patients often felt that GP follow-up was inadequate. These results suggest that the therapeutic benefit of the GP consultation is under-recognized in current guidelines. The results of our study will provide crucial information as to how such consultations can be tailored to improve patient satisfaction.

Profiles, Correlates and Outcomes Among Patients Experiencing an Onset of Mental Disorder Based on Outpatient Care Received Following Index Emergency Department Visits.

This 5-year longitudinal study evaluated patients with an onset of mental disorder (MD) following index emergency department (ED) visits, in terms of (1) patient profiles based on 12-month outpatient follow-up care received, (2) sociodemographic and clinical correlates, and (3) adverse health outcomes for the subsequent 2 years. Data from administrative databases were collected for 2541 patients with an onset of MD, following discharge from Quebec ED. Latent class analysis was performed to identify patient profiles based on the adequacy of follow-up care after ED discharge. Bivariate analyses examined associations between class membership and sociodemographic and clinical correlates, high ED use (3 + visits/yearly), hospitalizations, and suicidal behaviors. Five classes of patients were identified. Class 1, the smallest, labeled "patient psychiatrist only," included mainly young patients with serious MD. Classes 2 and 3, roughly 20%, were labeled "high use of patient general practitioner (GP) and psychiatrist" and "low use of patient GP and psychiatrist," respectively. Both included patients with complex MD, but Class 2 had more women and older patients with chronic physical illnesses. The 2 largest classes were labeled "no usual patient service provider" (Class 5) and "patient GP only" (Class 4). Class 5 included more younger men with substance-related disorders, while Class 4 had the older patients living in rural areas, many with common MD and chronic physical illnesses. Class 3 patients had the poorest outcomes, followed by Classes 1 and 2, while Classes 4 and 5 had the best outcomes. Results revealed that nearly 40% of patients experiencing an onset of MD received little or no outpatient care following ED discharge. Higher severity or complexity of MD and, to a lesser extent, no or low GP follow-up may explain these adverse outcomes. More adequate, continuous care, including collaborative care, is needed for these vulnerable, high-needs patients.

Long-term satisfaction with curative treatment and follow-up in prostate cancer survivors

Purpose In a cross-sectional observational study to explore long-term satisfaction with treatment among men who had undergone radical prostatectomy (RP) or definitive pelvic radiotherapy (RT) for prostate cancer (PCa). Methods After mean 7 years from therapy (range: 6–8), 431 PCa-survivors (RP: n = 313, RT: n = 118) completed a mailed questionnaire assessing persistent treatment-related adverse effects (AEs) (Expanded Prostate cancer Index Composite [EPIC-26]) and seven Quality indicators describing satisfaction with the health care service following a most often general practitioner (GP)-led follow-up plan. A logistic regression model evaluated the associations between long-term satisfaction and treatment modality, age, the seven satisfaction-related Quality indicators, and persistent AEs. The significance level was set at p< .05. Results Four of five (81%) PCa-survivors reported long-term satisfaction with their treatment. In a multivariable model, satisfaction was positively associated with sufficient information about treatment and AEs, patient-perceived sufficient cooperation between the hospital and the GP and sufficient follow-up of AEs (ref.: insufficient). Age ≥70 years (ref.: <70) and a rising summary score within the EPIC-26 sexual domain additionally increased long-term satisfaction. The treatment modality itself (RP versus RT) did not significantly impact on satisfaction. Conclusions The majority of curatively treated PCa-survivors are satisfied with their treatment more than 5 years after primary therapy. Sufficient information, improved cooperation between the hospital specialists and the responsible GP and optimized follow-up of AEs may further increase long-term satisfaction among prostatectomized and irradiated PCa-survivors.

Defining Biochemical Cure After Low Dose Rate Prostate Brachytherapy: External Validation of 4-year Prostate-specific Antigen Nadir as a Predictor of 10- and 15-year Disease-free Survival

AimsTo externally validate a proposed biochemical definition of cure following low dose rate (LDR) brachytherapy for prostate cancer – 4-year post-implant prostate-specific antigen (PSA) ≤0.2 ng/ml – in a UK population, and report the long-term (10- and 15-year) outcomes for patients stratified by National Comprehensive Cancer Network (NCCN) risk groups, through analysis of a large, prospectively collected, single-centre database. Materials and methodsAll patients treated with LDR brachytherapy for prostate cancer at a single UK centre between 2001 and November 2020 (n = 1142) were eligible; 632 patients met the inclusion criteria for the analysis. The primary end point was disease-free survival (DFS), defined as freedom from clinical, radiological or PSA progression requiring androgen deprivation therapy. Four-year PSA was categorised as ≤0.2, >0.2 to ≤0.5, >0.5 to ≤1.0 and >1.0 ng/ml. Kaplan–Meier analysis to 15 years was undertaken for each group, and sensitivity and specificity of 4-year PSA as a surrogate for long-term cure were calculated. Kaplan–Meier analysis to 15 years was repeated, stratifying patients by NCCN risk groups. ResultsThe median cohort age was 63 years; the median follow-up was 9.1 years (range 3.5–18.7). In total, 248 patients were available for analysis at year 10, 46 at year 15. Sixty-four patients (10.1%) relapsed during the study period. The 10-year DFS for 4-year PSA categories ≤0.2, >0.2 to ≤0.5, >0.5 to ≤1.0 and >1.0 ng/ml (95% confidence intervals) were 97.5% (95.4–99.6), 89.0% (82.4–96.1), 81.5% (70.5–94.2) and 41.8% (29.7–58.9), respectively. The 10-year DFS results for NCCN low, favourable-intermediate and unfavourable-intermediate risk disease were 93.1% (89.6–96.7), 92.1% (87.6–96.9) and 75.9% (67.8–84.9), respectively. ConclusionsPatients with 4-year PSA ≤0.2 ng/ml may be considered cured, and could be discharged to general practitioner follow-up. LDR brachytherapy is an excellent treatment option for patients with low and favourable-intermediate risk prostate cancer, but those with unfavourable-intermediate risk disease should be considered for treatment intensification strategies.

Assessing the use of antibiotics and the burden of varicella in Belgium using a retrospective GP database analysis

BackgroundVaricella is a highly contagious infection that typically occurs in childhood. While most cases have a generally benign outcome, infection results in a considerable healthcare burden and serious complications may occur.ObjectivesThe objective of this study was to characterize the burden of varicella in a real-world primary care setting in Belgium, including the rate of varicella-related complications, medication management and general practitioner (GP) visits.MethodsThe study was a retrospective observational study using data from a longitudinal patient database in a primary care setting in Belgium. Patients with a GP visit and a varicella diagnosis between January 2016 and June 2019 were eligible and data one month prior and three months after the diagnosis were included. Outcomes included varicella-related complications, antibiotic use, antiviral use, and GP follow-up visits. Antibiotic use could be specified by class of antibiotic and linked to a diagnosis. Complications were identified based on concomitant diagnosis with varicella during the study period.Results3,847 patients with diagnosis of varicella were included, with a mean age of 8.4 years and a comparable distribution of gender. 12.6% of patients with varicella had a concomitant diagnosis of a varicella-related complication. During the follow-up period, 27.3% of patients with varicella were prescribed antibiotics, either systemic (19.8%) and/or topical (10.3%). The highest rate of antibiotic prescriptions was observed in patients with complications (63.5%) and in patients younger than 1 year (41.8%). Nevertheless, 5.3% of the patients were prescribed antibiotics without a concomitant diagnosis of another infection. The most commonly prescribed systemic antibiotics were amoxicillin alone or combined with beta-lactamase inhibitor, and thiamphenicol. Fusidic acid and tobramycin were the most prescribed topical antibiotics. Antivirals were prescribed for 2.7% of the study population. 4.7% of the patients needed a follow-up visit with their GP.ConclusionsThis study reports a substantial burden of varicella in a primary care setting in Belgium, with high rates of complications and antibiotic use.

586 Peri-Pancreatic Migration of Lost Intra Uterine Device: Case Report and Review of Literature

Abstract Intra uterine devices (IUDs) is one of the most effective form of contraception available today. Uterine perforation and IUD migration is a rare but serious complication and is reported to occur in 0.05 to 13 cases out of 1000 IUCD placements. Migration of IUD to pelvis and lower abdominal organs following uterine perforation has been reported widely in literature. However far migration into the upper abdomen in very rare. Here we report a case asymptomatic peri-pancreatic migration of IUD. A 65-year-old lady being investigated for pneumonia was picked up to have an asymptomatic IUD lying in front of the pancreas. The patient recalled having a hormonal Mirena coil placed 12 years previously for menopausal symptoms. Routine 3-year general practitioner follow-up failed to detect the IUD on vaginal examination. The patient denied spontaneous IUD discharge. However, three subsequent pelvic ultrasound scans did not detect any retained IUD and she was discharged as unrecognized IUD expulsion. She remained asymptomatic for the next 12 years with no abdominal symptoms though she did report to the General Practitioner, multiple episodes of new onset hot flushes when opening bowels - which was managed conservatively with reassurance. It was decided to surgically remove the IUD. Intraoperatively, the IUD was found densely adherent to the lesser omentum close to the pancreas and stomach and was removed safely laparoscopically. The patient made a good postoperative overnight recovery and was discharged. Intra-abdominal migration of IUDs is a very rare complication of IUD insertion and when detected should be promptly treated with Laparoscopic removal.

Improving detection and management of familial hypercholesterolaemia in Australian general practice

ObjectiveFamilial hypercholesterolaemia (FH) is characterised by elevated low-density lipoprotein (LDL)-cholesterol and increased risk of cardiovascular disease. However, FH remains substantially underdiagnosed and undertreated. We employed a two-stage pragmatic approach to...

Outpatient surgical management of non-melanoma skin cancers of the head and neck in a regional centre: an analysis of costs and outcomes.

Non-melanoma skin cancer is the most commonly diagnosed malignancy in Australia. Lesions of the head and neck are often outside the scope of primary care providers. The challenges of cancer care in regional Australia necessitate careful resource planning. This study presents an outpatient model that minimizes health service cost with local general practitioner follow-up. A retrospective review of 105 patients with 122 skin lesions in a dedicated Facial Lesion Assessment Management and Excision clinic was performed from July 2018 to 2019. Clinical outcomes, patient travel and cost analysis/comparison were recorded. There were 85 malignant cases with 59 basal cell carcinomas and 25 squamous cell carcinomas. For basal cell carcinoma, clear margins (≥3 mm), close margins (<3 mm) and positive margins were achieved in 24 (48%), 23 (46%) and three (6%) cases, respectively. For squamous cell carcinoma, clear margins (≥5 mm), close margins (<5 mm) and positive margins were achieved in seven (38.8%), 11 (61.1%) and none (0%) of the cases, respectively. Complications included one haematoma and two wound infections. For 37% of patients living >100 km from the department, 72.3% had local general practitioner follow-up. Inpatient cost was $2870, $5697 and $9300 for primary closure, local flap and full-thickness skin graft, respectively, and outpatient cost was $746 for a single facial lesion. This study presents a cost-effective model for the management of non-melanoma skin cancers with improved departmental efficiency and streamlined patient care in an outpatient skin cancer management model in a regional centre.

General practitioner follow-up after hospitalisation in Central and Eastern Sydney, Australia: access and impact on health services.

Objectives General practitioner (GP) follow-up after a hospital admission is an important indicator of integrated care. We examined the characteristics of patients who saw a GP within 2 weeks of hospital discharge in the Central and Eastern Sydney (CES) region, Australia, and the relationship between GP follow-up and subsequent hospitalisation. Methods This data linkage study used a cohort of 10240 people from the 45 and Up Study who resided in CES and experienced an overnight hospitalisation in the 5 years following recruitment (2007-14). Characteristics of participants who saw a GP within 2 weeks of discharge were compared with those who did not using generalised linear models. Time to subsequent hospitalisation was compared for the two groups using Cox proportional hazards regression models stratified by prior frequency of GP use. Results Within 2 weeks of discharge, 64.3% participants saw a GP. Seeing a GP within 2 weeks of discharge was associated with lower rates of rehospitalisation for infrequent GP users (i.e. <8 visits in year before the index hospitalisation; hazard ratio (HR) 0.83; 95% confidence interval (CI) 0.70-0.97) but not frequent GP users (i.e. ≥8 plus visits; HR 1.02; 95% CI 0.90-1.17). Conclusion The effect of seeing a GP on subsequent hospitalisation was protective but differed depending on patient care needs. What is known about the topic? There is general consensus among healthcare providers that primary care is a significant source of ongoing health care provision. What does this paper add? This study explored the relationship between GP follow-up after an uncomplicated hospitalisation and its effect on rehospitalisation. What are the implications for practitioners? Discharge planning and the transfer of care from hospital to GP through discharge arrangements have substantial benefits for both patients and the health system.

P1432THE PRE-DIALYSIS CARE TRAJECTORIES OF ESRD PATIENTS: WHAT TYPES AND WHAT FACTORS OF EMERGENCY DIALYSIS START?

Abstract Background and Aims According to the REIN registry, in France in 2017, 30% of incident end-stage renal disease (ESRD) patients started dialysis in emergency. Emergency dialysis start (ES) is associated with higher risks of morbidity and mortality as well as a decreased quality of life for patients. The objectives were to describe groups of patients with similar care trajectories (or “types”) and identify the factors associated with ES. Method Data from the French REIN registry linked with the French national health insurance database (SNDS) were used. Patients aged 18 years old and older who started dialysis in 2015 in France were included. The 2 years pre-dialysis care trajectory was defined using 8 key components of ambulatory and hospital CKD care consumption. Multiple Correspondence Analysis (MCA) on these components was performed before a Hierarchical Clustering on Principal Components (HCPC) in order to identify types of care trajectories. Logistic regression models including both patients’ characteristics and the key CKD healthcare consumption were used to identify factors associated with ES. Results Among the 8856 patients included, 2681 (30.3%) started dialysis in emergency. The HCPC identified 6 types of pre-dialysis care trajectories. ES rate ranged from 11% to 62% depending on the type. Patient’s profiles were also different between types of trajectories, including age and comorbidities (diabetes prevalence ranged from 22% to 56%). For example, the 5th and 6th types of pre-dialysis care trajectories with high ES rates were characterized by low and absent CKD healthcare consumption respectively. They were shared by younger and less comorbid patients (26.7% and 25.7% aged &amp;lt; 45 years old, 66.5% and 59.4% without any cardiovascular diseases respectively). Conversely to the absence of nephrologist follow-up, the absence of general practitioner follow-up was not significantly associated with ES (OR=1.83, CI 95% [1.58-2.13] and OR=0.79, CI 95% [0.61-1.04] respectively). Conclusion Exploiting the strength of the combined use of clinical and healthcare consumption data, our study shows the diversity of pre-dialysis care trajectories of CKD patients. While some of these types of trajectories can be explained by patients’ clinical and demographic characteristics, complementary qualitative approaches are required to fully understand ES. Some types, as well as ES associated factors, highlight the need for earlier CKD screening and nephrologist referral.

Management of acute COPD exacerbations in Australia: do we follow the guidelines?

ObjectiveWe aimed to assess adherence to the Australian national guideline (COPD-X) against audited practice, and to document the outcomes of patients hospitalised with an acute exacerbation of chronic obstructive pulmonary disease (COPD) at discharge and 28 days after.MethodsA prospective clinical audit of COPD hospital admission from five tertiary care hospitals in five states of Australia was conducted. Post-discharge follow-up was conducted via telephone to assess for readmission and health status.ResultsThere were 207 admissions for acute exacerbation (171 patients; mean 70.2 years old; 50.3% males). Readmission rates at 28 days were 25.4%, with one (0.6%) death during admission and eight (6.1%) post-discharge within 28 days. Concordance to the COPD-X guidance was variable; 22.7% performed spirometry, 81.1% had blood gases collected when forced expiratory volume in 1 s was <1 L, 99.5% had chest radiography performed, 95.1% were prescribed systemic corticosteroids and 95% were prescribed antibiotic therapy. There were 89.1% given oxygen therapy and 92.6% when arterial oxygen tension was <80 mmHg; 65.6% were given ventilatory assistance when pH was <7.35. Only 32.4% were referred to pulmonary rehabilitation but 76.8% had general practitioner follow-up arranged.ConclusionWhen compared against clinical practice guidelines, we found important gaps in management of patients admitted with COPD throughout tertiary care centres in Australia. Strategies to improve guideline uptake are needed to optimise care.

Effectiveness of discharge education strategies versus usual care on clinical outcomes in acute coronary syndrome patients: a systematic review.

The objective of this review was to systematically review studies that evaluated the clinical effectiveness of hospital discharge education strategies provided to patients with acute coronary syndrome (ACS). In an era of shortening lengths of stay for patients with ACS, bedside education opportunities are diminishing; however, the importance of discharge education on medication management, emergency procedures and safe recovery remains vital to prevent rehospitalization. The following studies were considered for inclusion: English-language randomized controlled trials (RCTs) measuring educational strategies provided to adults with ACS as the only intervention prior to discharge or post-discharge from acute care, compared to usual care. An electronic search was performed by an experienced research librarian. MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Australian New Zealand Clinical Trials Registry, ClinicalTrials.gov and WHO International Clinical Trial Registry Platform were searched for studies published between 2000 and 2017. All citations were collated and uploaded into EndNote where duplicates were removed. Titles and abstracts were screened by two independent reviewers. The reference lists of all included studies were screened for additional references. Risk of bias was assessed using the JBI critical appraisal instrument for all included studies. In the case of missing or incomplete data, corresponding authors were contacted. The primary outcomes of interest were knowledge relating to ACS diagnosis, treatment and procedures. Secondary outcomes included lifestyle modifications, medication adherence/knowledge, general practitioner follow-up, attendance to cardiac rehabilitation (CR), readmission and mortality (up to 12 months). As data were collected using different instruments in each study, meta-analysis was not performed. The electronic search identified 3445 records. Following deduplication, 2093 citations were screened with 47 papers selected for assessment of eligibility. Three RCTs involving 175 participants were identified for inclusion. The certainty of this evidence (Grading of Recommendations, Assessment, Development and Evaluation) was rated as low to moderate. The risk of bias for all included studies was moderate. In all studies, the impact of inpatient educational interventions was assessed in relation to attendance to a CR program, exercise rates and medication adherence. Interventions included targeted educational sessions (15-40 minutes) where participants prioritized their learning needs and were provided tailored cardioprotective risk factor and lifestyle modification advice and invited to attend a CR program. One study presented the education in animation. In one study, intervention groups reported increased attendance to CR compared to control (47.3%; n = 9, versus 21.1%; n = 4) and another demonstrated significantly increased exercise rates from baseline to follow-up. No significant difference was reported between the intervention and control for medication adherence, and none of the studies reported readmission or mortality rates. The current review found little to no evidence for the effectiveness of current discharge practices on clinical outcomes. There has been limited research on modes of delivery or what the essential components for ACS discharge education should be. This review has highlighted the need for comprehensive effectiveness studies to provide a strong evidence-base to support ACS discharge practices. PROSPERO CRD42018094781.

Rates and predictors of general practitioner (GP) follow-up postdischarge from a tertiary hospital cardiology unit: a retrospective cohort study

ObjectivePrevious studies in cardiac patients noted that early patient follow-up with general practitioners (GPs) after hospital discharge was associated with reduced rates of hospital readmissions. We aimed to identify patient,...

Case finding for dementia during acute hospital admissions: a mixed-methods study exploring the impacts on patient care after discharge and costs for the English National Health Service

ObjectiveBetween 2012 and 2017 dementia case finding was routinely carried out on people aged 75 years and over with unplanned admissions to acute hospitals across England. The assumption was that...

Care of general practice patients preceding and following a suicide attempt: observational study in Flemish general practices

ObjectivesFirst, to examine general practitioner (GP) knowledge about the care (needs) of their patients; second, to examine the quality of GP follow-up care; third, to examine the transmission of patient...