Follow-up study of chronically ill patients discharged from hospital

Abstract

A study was made of 82 patients with selected illnesses of specified severity before and after discharge from the ward services of three general hospitals in a metropolitan community. An initial appraisal was made by a resident physician who evaluated the health status of each patient and made recommendations for care and supervision following discharge from hospital. After an average period of 3 months, each patient was visited by a student of social work who reconstructed the course of events following discharge and determined the extent to which the physicians' recommendations were complied with and the reasons for non-compliance. The usual consequences of chronic illness--persistent disability, unemployment and recurrent and lengthy institutionalization--were amply evident in this group. So was the fact that the burden of continued care falls heavily upon the members of the family. Other sources of help were trivial by comparison. The recommendations made by the discharging physician constitute an interesting, and sobering, inventory of continued need for care. More than a half of all patients did not comply with one or more recommendations made by the physician. In addition, about 40 per cent of patients reported unmet need for one or more services touching upon many aspects of medical care. A variety of lessons relevant to the organized provision of care may be drawn from a consideration of the services needed and desired by patients and of the reasons for, and factors related to, non-compliance with medical recommendations.