Survey of carers of elderly patients discharged from hospital.

As part of a study to determine reasons for early unplanned readmission of elderly patients to hospital, the problems experienced by the carers of two groups of patients aged 65 years and over were analysed. Carers of 100 patients who had been readmitted in an emergency and 93 control patients were interviewed. The majority of carers were aged 60 year or over and two thirds were women. Forty one per cent of the carers were the patient's spouse. Forty per cent of the carers did not live with the patient. Many of the carers had been attending to the personal and domestic needs of their dependents for a considerable time. Carers complained about the effect the task had on their own health and the high levels of frustration experienced. Carer problems were important principal and contributory reasons for readmission. Carers of readmitted patients experienced more problems, frustrations and concerns than the carers of control patients. It is suggested that communication between professionals and carers should be improved, and, in particular, that the needs of carers should be assessed before discharge of patients from hospital.

Use of nursing and social services by elderly patients discharged from hospital.

As part of a study to determine reasons for early unplanned readmission of elderly patients to hospital, the provision of nursing and social services before and after admission was assessed for two groups of patients aged 65 years and over. A random sample of 133 patients who had been readmitted in an emergency and 133 matched controls who had not been readmitted were interviewed. Prior to the first admission the readmitted patients had received more services than the control patients. A substantial number of patients had had some services organized for them before leaving hospital. There was a net increase in the provision of district nursing services for both groups. The readmitted group had significantly more nursing and social services both before and after discharge than the non-readmitted group. The level of district nursing, home help and social work all increased significantly with age. Problems were experienced with services after discharge from hospital. These included: no arrangements, delay in starting services and inadequate services to meet the patient's needs. Guidelines for the provision of nursing and social services after discharge of patients from hospital are suggested.

General practitioner response to elderly patients discharged from hospital.

OBJECTIVE: To determine the effect of discharge information given to general practitioners on their management of newly discharged elderly patients. DESIGN: A random sample of 133 elderly patients who had unplanned readmission to a district general hospital within 28 days of discharge was compared with a matched control sample of patients who were not readmitted. Information was gathered from the hospital, the patients, the carers, and the general practitioners about the information that the hospital had sent the general practitioner and the general practitioners' response to this information. SETTING: All specialties in a district general hospital. PATIENTS: 266 Patients aged over 65 representative in the main demographic indices of the population of elderly patients admitted to hospital. RESULTS: Ten weeks after discharge the doctors had received notice of discharge about 169 of the patients, but fewer than half the discharge notices were received within the first week. General practitioners were dissatisfied with the information in 60 cases. A general practitioner visited 174 of the patients after their discharge from hospital and three quarters of the visits took place within two weeks of the discharge. These visits were more likely to have been initiated by patients or families than by the doctor, and this was not influenced by the doctor receiving notice of the patient's discharge. Older patients and those who had carers were the most likely to be visited. Nearly half of the carers were dissatisfied with some aspect of general practitioner care, problems with home visiting being the commonest source of complaint. CONCLUSIONS: Hospital communications to general practitioners about the discharge of elderly patients still cause concern, particularly in the time they take to arrive. Written instruction to vulnerable elderly patients asking them to inform their general practitioner of the discharge might be helpful. Carers complained of lack of support, and it is clearly important for someone (either the general practitioner or another health worker) to visit elderly people shortly after their discharge.

Factors affecting early unplanned readmission of elderly patients to hospital.

A random sample of 133 elderly patients who had an unplanned readmission to a district general hospital within 28 days of discharge from hospital was studied and compared with a matched control sample of patients who were not readmitted. The total group was drawn from all specialties in the hospital, and by interviewing the patients, their carers, the ward sisters, and the patients' general practitioners the factors causing early unplanned readmission for each patient were identified. Seven possible principal reasons were found: relapse of original condition, development of a new problem, carer problems, complications of the initial illness, need for terminal care, problems with medication, and problems with services. There were also contributory reasons, and it was usual for several of these to be present in each case. The unplanned readmission rate was 6%; the planned readmission rate was 3%. It was thought that unplanned readmission was avoidable for 78 (59%) patients. Patients in the study group and in the control group showed significant differences in certain characteristics--such as low income, previous hospital admission, already having nursing care, and admission by general practitioners--and this might help to identify patients who are likely to be readmitted in an emergency.

The cost of prescribing in general practice.

Costs to the National Health Service and to the patients were determined for a sample of 77 patients who had consulted their doctor about back pain, depression or eczema. One of the main costs of the Health Service was for medication. Prescription forms were traced and costed after dispensing. Costs to patients included monetary aspects, side effects of medication and socio-emotional responses to illness. The Nottingham Health Profile was used to measure the latter on a time-scale series. Consultations with patients who had eczema were most likely to result in medication being prescribed. The mean cost of medication throughout the episode of illness was highest for those who had consulted about depression. Patients reported that 59 (61%) of prescribed items resulted in an improvement of the condition. This was likely to occur most often with treatment for eczema and least likely for patients who had back pain. Non-monetary costs, e.g. disruption of social life, were found to be highest in relation to depression.