Clinical handover for outpatients with chronic health conditions accessing government healthcare in Himachal Pradesh, India
By Claire Humphries, MPH (International) Student
This project has been conceived and designed with the aim of contributing to literature that will enhance the continuity and overall quality of health care in low and middle-income countries (LMICs).
Introduction: Clinical handover has been defined as “the transfer of professional responsibility and accountability for some or all aspects of a patient’s or a group of patients’ care to another person or professional group on a temporary or permanent basis” (1). The importance of this aspect of healthcare is evidenced by findings that substandard handovers (e.g. during discharges from hospital) can lead to subsequent increases in re-hospitalisation and decreases in quality of healthcare (2). Despite the quantity of research that currently exists regarding clinical handover, only a limited amount of good quality literature has been produced on the topic and global gaps in policy and proven interventions still exist (3). In addition, the majority of research published has been provided by and for developed nations, with the same type of work lacking across LMICs. This is especially problematic as LMICs are more likely to frequently experience adverse events due to poor handover, result from reduced/non-existent healthcare providers integration.
India being the nation of focus for this study is an opportune selection due to its various and complex health systems being at such a pivotal point in development. The more recent emergence of primary care systems have had mixed successes nationwide (4) and are generally poorly integrated with secondary care.
Aim: The overall aim of this research is to establish current clinical handover practices for outpatients and any patient and systems-based factors that are affecting handover communications between primary and secondary care for patients with chronic health conditions in Solan District, India.
Methods: Patients visiting Solan Regional Hospital were interviewed before and after outpatient appointments using a questionnaire, with questions focusing on the provision of handover documentation, clinician recommendations for future healthcare and patients viewpoints on healthcare providers and the information they receive from them. Descriptive statistics will be utilised to establish current practices regarding the provision of handover documentation and patient/healthcare-related factors that are facilitating/obstructing handover communications. Inferential statistics are to be utilised to investigate whether significant associations exist between particular patient background characteristics and the likelihood of being provided with certain documented handover information.
Closing Comments: The focus of this research on the provision of paper-based handover documentation is important due to current absence of electronic patients records and inadequacies in paper-based record keeping in government healthcare facilities in India. Therefore, at present patient handover documents are often the only source of vital handover information for patients when visiting healthcare providers. In addition, the discernment of current patient and system-based facilitators and barriers to handover communications from this research will help to produce informed recommendations of feasible interventions. Such interventions may ameliorate healthcare system integration and efficiency. Ultimately, this is likely to assist in strengthening the Indian public sector’s ability to enhance the provision of affordable primary, secondary and tertiary healthcare.
References:
- The Royal Australian College of General Practitioners. Standards for general practices. 4th ed. East Melbourne, Australia: The Royal Australian College of General Practitioners [Internet]. 2010 [cited 2015 Feb 3].
- Hesselink G, Schoonhoven L, Barach P, Spijker A, Gademan P, Kalkman C, et al. Improving patient handovers from hospital to primary Care. A systematic review. Ann Intern Med [Internet]. 2012 [cited 2015 Jan 27]; 157(6):417-428.
- Australian Council for Safety and Quality in Health Care. Clinical handover and patient safety – literature review report. Canberra (Australia) Australian Council for Safety and Quality in Health Care [Internet]. 2005 [cited 2015 Jan 27].
- Varatharajan D, Thankappan R, Jayapalan S. Assessing the performance of primary health centres under decentralized government in Kerala, India. Health Policy Plan [Internet]. 2004 [cited 2015 Jan 30]; 19(1): 41-5.
