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Management of Discharge Instructions for Children With Medical Complexity: A Systematic Review
Alexander F Glick1, Jonathan S Farkas1, Juliana Magro2
1Department of Pediatrics.
Pediatrics
|October 17, 2023
Summary
Understanding discharge instructions is crucial for children with medical complexity (CMC). Caregiver comprehension and adherence are influenced by various factors, highlighting the need for better interventions during care transitions.
Area of Science:
- Pediatric Healthcare
- Health Services Research
- Patient Safety
Background:
- Children with medical complexity (CMC) face significant risks post-discharge due to challenges in understanding and adhering to medical instructions.
- Existing literature lacks comprehensive reviews on factors influencing discharge instruction comprehension and adherence in CMC.
- Identifying these factors is critical for improving patient outcomes and reducing readmissions.
Approach:
- A systematic literature review was conducted using multiple databases (PubMed/Medline, Embase, Cochrane, PsycInfo, CINAHL, Web of Science, OAIster) up to March 2023.
- Original studies focusing on caregiver comprehension and adherence to discharge instructions for CMC were included.
- Data extraction and analysis were performed by two independent reviewers.
Key Points:
- Fifty-one studies were included, with a predominance of qualitative or mixed-methods research; few examined objective outcomes.
- Common barriers included issues with access, care coordination, and caregiver stress/anxiety.
- Facilitators involved considering the family's context and employing health literacy-informed strategies, particularly for equipment-related instructions.
Conclusions:
- Numerous factors impact discharge instruction comprehension and adherence for CMC.
- Specific areas like appointment management and feeding tube care require further investigation.
- Future research should prioritize the development of interventions to optimize care transitions for this vulnerable population.
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