RESUMO
AIM: This paper is a report of a study conducted to evaluate, from the patients' perspective, a Liaison and Continuity of Care Programme coordinating care provision between a hospital and primary care centres. BACKGROUND: Promoting continuity of care between hospitals and primary care improves quality of care, patient satisfaction and decreases further hospitalizations. However, inadequate pain management is common after discharge. METHOD: A sample of patients from the Liaison and Continuity of Care Programme were included in a longitudinal study in 2007. We conducted standardized telephone interviews at 24 hours, 7 days, 1 and 3 months after discharge. Outcome measures included readmission, time between hospital discharge and readmission, information level at discharge, patient satisfaction, queries about care and information related to perceived state of health and pain. RESULTS: Eighty-three adult patients (average age 69.3, 50.6% males) who needed continued care at discharge were followed. Ten participants died during follow-up, and seven required readmission. A total of 49.4% of patients stated that they had understood the information given at discharge very well or perfectly. At 24 hours after discharge, 30% already had doubts about their state of health and the management of their condition. In relation to perceived health, only 25.3% stated that this was good or very good. Prevalence of pain 24-hours after discharge was 58.3% in surgical patients and 17.1% in other patients. CONCLUSION: The preparation and education of patients and family members should be improved before discharge, and appropriate written information must be given, especially if a patient has pain or requires complex care.
