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Patient and healthcare provider knowledge, attitudes and barriers to handover and healthcare communication during chronic disease inpatient care in India : a qualitative exploratory study
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Humphries, Claire, Jaganathan, Suganthi, Panniyammaka, Jeemon, Singh, Sanjeev K., Goenka, Shifalika, Dorairaj, Prabhakaran, Gill, Paramjit, Greenfield, Sheila, Lilford, Richard and Manaseki-Holland, Semira (2019) Patient and healthcare provider knowledge, attitudes and barriers to handover and healthcare communication during chronic disease inpatient care in India : a qualitative exploratory study. BMJ Open, 9 . e028199. doi:10.1136/bmjopen-2018-028199 ISSN 2044-6055.
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Official URL: http://www.doi.org/ 10.1136/bmjopen-2018-028199
Abstract
Objectives 1. To investigate patient and healthcare provider knowledge (HCP), attitudes and barriers to handover communication during inpatient care. 2. To explore potential interventions for improving the storage and transfer of critical healthcare information.
Methods Design: Qualitative study comprising 41 semi-structured, individual interviews. Thematic analysis using the Framework Method with analyst triangulation. Setting: Three hospitals in Himachal Pradesh and Kerala, India. Participants: 20 male (n=10) and female (n=10) chronic NCD patients and 21 male (n=15) and female (n=6) HPCs. Purposive sampling was used to identify patients with chronic NCDs (Chronic Respiratory Disease, Cardiovascular Disease, Diabetes or Hypertension) and HCPs working in the study hospitals.
Results For chronic NCD patients, three themes emerged: (1) Public healthcare service characteristics; (2) HCP-patient communication; (3) Attitudes regarding medical information. For HCPs, three themes emerged: (1) System factors; (2) Information exchange practices; (3) Quality improvement strategies. Whilst some content within themes was unique to each participant group, there was substantial overlap. Both patients and HCPs recognised constraints affecting public healthcare; deficient primary care services placed increased pressure on hospitals, subsequently limiting HCP consultation times. HCP and IP reports also indicated an absence of structured referral formats, resulting in fragmented information transfer. Additionally, whilst patient-held documents were a key vehicle for information exchange between HCPs, not all patients transported them and HCPs stated that this hindered continuity of care. Inpatient descriptions of HCP communication indicated notable inconsistencies and a lack of patient-centeredness. HCPs reported systemic issues such as absence of formal handover communication systems and training.
Conclusions Handover communication for chronic NCD patients visiting public hospitals in India is currently suboptimal. Structured information exchange systems are urgently required to improve quality, continuity and safety of care. Our findings indicate that well-designed patient-held record booklets may be an acceptable and effective part of the solution.
| Item Type: | Journal Article | |||||||||||||||
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| Subjects: | R Medicine > R Medicine (General) | |||||||||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Communication in medicine -- India, Physician and patient , Chronic diseases -- India, Confidential communications -- Physicians | |||||||||||||||
| Journal or Publication Title: | BMJ Open | |||||||||||||||
| Publisher: | BMJ | |||||||||||||||
| ISSN: | 2044-6055 | |||||||||||||||
| Official Date: | 2019 | |||||||||||||||
| Dates: |
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| Volume: | 9 | |||||||||||||||
| Article Number: | e028199 | |||||||||||||||
| DOI: | 10.1136/bmjopen-2018-028199 | |||||||||||||||
| Status: | Peer Reviewed | |||||||||||||||
| Publication Status: | Published | |||||||||||||||
| Access rights to Published version: | Restricted or Subscription Access | |||||||||||||||
| Date of first compliant deposit: | 21 November 2019 | |||||||||||||||
| Date of first compliant Open Access: | 21 November 2019 | |||||||||||||||
| RIOXX Funder/Project Grant: |
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