Impact of Medical Follow-up Discharge Package (RECALL-CT)

University of Cape Town (UCT)

Status: Withdrawn

Conditions: Medical In-patients; Follow-up Study

Treatments: Other: Integrated medical follow-up package

Study type: Interventional

Funder types: Other

Identifiers

NCT01916876

UCT 148.2/2013

Details and patient eligibility

About

The post discharge time is a vulnerable time for general medical in-patients, with high rates of adverse events that may cause unnecessary readmissions and even death. A recent study of 415 patients discharged from the general medical wards at Groote Schuur Hospital, demonstrated a very high 12 month mortality of 35%. The majority of these deaths were classified as "unexpected". The reasons for this were not further examined, but it was speculated, given the authors' knowledge of the public sector in Cape Town, that three related factors contribute significantly to this early mortality: i) a lack of continuity of care, with patients not necessarily accessing the primary care support treatment that they need or being able to access early post discharge follow-up (for example for anti-retroviral or anti-tuberculous care); ii) the inability of primary care to deal with the complex nature of the discharged patients, most whom have significant co-morbid disease; iii) A lack of optimisation of therapy for chronic disease after acute discharge.

The investigators hypothesise that an integrated post-discharge transitional care package, which includes an early medical specialist follow-up in the first 3 months after hospital discharge will decrease the 6- and 12-month mortality and re-admission rate amongst general medical hospital admissions in Cape Town, South Africa. Our study will compare an integrated package, suitable to implementation if effective, with current standard discharge packages.

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Patients referred for admission to general medical wards (including within hospital transfer e.g. ICU discharge)
2. >18 years and willing to give informed consent

Exclusion criteria

1. Patient admitted directly to intensive care unit
2. Patient refusing consent or <18 years old
3. Patients electively admitted
4. Patients without phone numbers who cannot provide any telephone contact details for a co-habitant, relative or neighbour.

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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0 participants in 2 patient groups

Standard Care

No Intervention group

Description:

At discharge, patients will be given a discharge plan by their attending caregiver as deemed appropriate.

Integrative medical follow-up package

Other group

Description:

At discharge, patients will receive a discharge plan by their attending caregiver. Thereafter, if randomised to this study arm they will receive the intervention as outlined elsewhere. "Integrated Medical Follow-up package"

Treatment:

Other: Integrated medical follow-up package