Improving the interface between specialist medical outpatients and primary health care.

Abstract

Most of the patients seen at medical specialist outpatients department in the acute hospital in Malta are in follow-up. Shared Care is a form of care that supports the transfer of these patients to Primary Care. The joint participation of general practitioners and medical specialists in the planned delivery of care is informed by an enhanced information exchange process. This study identified measures that are necessary to improve the information exchange and sharing of patient responsibility with the public and private general practitioners at Primary Care level. The main purpose was to develop a Discharge/Shared Care Protocol that could be used at medical outpatients to improve the interface between Primary Care and Specialist outpatient clinic. General practitioners, hospital specialists and top management were asked about the appropriateness and implications of the discharge of these patients to Primary Care. Utilising a qualitative/action research approach two general practitioners and two consultants participated in the development of the Shared Care Protocol. Among the factors mentioned to contribute to effective Shared Care were the continuity of care in Primary Care, definition of roles, organisation of consultations, and the flow of information between the two departments. The use of the developed protocol appeared to improve the communication process at the interface between general practitioners and specialists; the practitioners were more satisfied with the information received from hospital specialists. Sharing the care of the patients discharged from outpatient clinics was also more appreciated in Primary Care, due to better guidance, specialists' accessibility and information supporting the patients' care. There are a number of issues arising from the findings of this study concerning the discharge of these patients that have an impact on effective Shared Care. Referral letters should spell out clearly the reasons for referral and the expectations of general practitioners. Discharge consultations should be accorded higher priority and allocated sufficient time. All discharges should be accompanied by a management plan for the general practitioners, including arrangements for gaining access to specialist care when needed. Above all however, improving the quality of a system of care, needs to be a common aim understood by all who use, work in, or influence, care across the interface.