Data from: Investigating clinical handover and healthcare communication for outpatients with chronic disease in India: a mixed-methods study

Objectives: Research concentrating on continuity of care for chronic,
non-communicable disease (NCD) patients in resource-constrained settings
is currently limited and focusses on inpatients. Outpatient care requires
attention as this is where NCD patients often seek treatment and optimal
handover of information is essential. We investigated handover, healthcare
communication and barriers to continuity of care for chronic NCD
outpatients in India. We also explored potential interventions for
improving storage and exchange of healthcare information. Methods: A
mixed-methods design was used across five healthcare facilities in Kerala
and Himachal Pradesh states. Questionnaires from 513 outpatients with
cardiovascular disease, chronic respiratory disease, or diabetes covered
the form and comprehensiveness of information exchange between healthcare
professionals (HCPs) and between HCPs and patients. Semi-structured
interviews with outpatients and HCPs explored handover, healthcare
communication and intervention ideas. Barriers to continuity of care were
identified through triangulation of all data sources. Results: Almost half
(46%) of patients self-referred to hospital outpatient clinics (OPCs).
Patient-held healthcare information was often poorly recorded on
unstructured sheets of paper; 24% of OPC documents contained the
following: diagnosis, medication, long-term care and follow-up
information. Just 55% of patients recalled receiving verbal follow-up and
medication instructions during OPC appointments. Qualitative themes
included patient preference for hospital visits, system factors,
inconsistent doctor-patient communication and attitudes towards medical
documents. Barriers were hospital time constraints, inconsistent referral
practices and absences of OPC medical record-keeping, structured
patient-held medical documents and clinical handover training. Patients
and HCPs were in favour of the introduction of patient-held booklets for
storing and transporting medical documents. Conclusions: Deficiencies in
communicative practices are compromising the continuity of chronic NCD
outpatient care. Targeted systems-based interventions are urgently
required to improve information provision and exchange. Our findings
indicate that well-designed patient-held booklets are likely to be an
acceptable, affordable and effective part of the solution.