Continuity of care: when do patients visit community health care providers after leaving hospital?

Abstract

Aims: To determine length of time from hospital discharge until a general practice, pharmacy or specialist visit, or care planning service. Design and participants: Retrospective analysis of Department of Veterans’ Affairs health claims data. All 109,860 veterans hospitalised in 2006 were included. Main outcome measures: Time from first hospital discharge to first claim for a general practice, pharmacy, specialist visit and/or care planning service. Results: Within 30 days of hospital discharge 71% of subjects visited a GP, 86% had medicines dispensed from a community pharmacy and 44% saw a specialist. Median time to first pharmacy visit was 6 days (interquartile range 2 – 14) and 12 days for a GP visit (interquartile range 4 – 31). Less than 2% of the cohort received a discharge plan, case conference or medication review in the month after discharge. Conclusions: With 25% of patients having a claim for a GP service within four days of discharge, discharge summaries need to reach community based health professionals within this time. Most patients visited their community pharmacy within two weeks of hospital discharge and before they saw their GP. Pharmacists are not routinely advised of hospitalisation or provided with discharge summaries. More active engagement of this professional group in the continuum of care may improve care after hospital discharge.