Background: In response to a national movement toward increasing value in health care, hospitals are seeking to better support patients after discharge. Older patients with functional limitations are frequently referred to receive home health care services at hospital discharge, including skilled nursing and therapy. Caregivers of patients with functional limitations receiving often have a key role in helping patients manage medications and appointments and could provide valuable insights about care coordination with providers following discharge. We completed a qualitative metasynthesis to describe experiences of care coordination from the perspective of caregivers for patients discharged from the hospital.
Methods: We completed a literature search in Ovid Medline and CINAHL on May 23, 2018 and identified 1,546 studies for review of which 1378 were excluded as abstracts. We then reviewed 165 full texts inclusion and exclusion criteria to identify qualitative articles that included adult caregivers in the United States, were in English, and focused on the transition from an acute care hospital to home. A total of 13 articles were included in the final meta-synthesis. A critical review tool by Letts and colleagues was completed for all included studies. Caregiver perspectives about care coordination were compiled into themes and mapped back to original themes using reciprocal translation. One author completed primary coding which was confirmed by a second author. Disagreements were resolved by a third author.
Results: Five main themes emerged from the analysis, which were all in the context of caregiver perspectives:
1) Suboptimal access to providers after discharge: caregivers are often uncertain whether to contact the discharging provider or the primary provider, they often are unable to reach any providers.
2) Overwhelming duties to manage appointments and medications: managing new prescriptions after discharge, and getting patients to all of their appointments is a challenge for caregivers.
3) Need for information and training at discharge: caregivers felt uninformed about how to manage the day to day care of their patient and how to deal with possible complications.
4) Disregard by Providers: caregivers often feel excluded from the discharge process, and that providers did not listen to their concerns.
5) Need for emotional support: taking care of a patient was often emotionally overwhelming, and caregivers felt they had little support in their new role.
Conclusions: The themes identified across the studies in this meta-synthesis suggest that caregivers often lack access to providers, information, and emotional support during the discharge process. There is a clear need to engage with caregivers in hospital and office settings to provide support, training, and communication access after hospital discharge