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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.
Insights
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.
Context:
Children with medical complexity (CMC) are at risk for adverse outcomes after discharge. Difficulties with comprehension of and adherence to discharge instructions contribute to these errors. Comprehensive reviews of patient-, caregiver-, provider-, and system-level characteristics and interventions associated with discharge instruction comprehension and adherence for CMC are lacking.
Objective:
To systematically review the literature related to factors associated with comprehension of and adherence to discharge instructions for CMC.
Data Sources:
PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, Web of Science (database initiation until March 2023), and OAIster (gray literature) were searched.
Study Selection:
Original studies examining caregiver comprehension of and adherence to discharge instructions for CMC (Patient Medical Complexity Algorithm) were evaluated.
Data Extraction:
Two authors independently screened titles/abstracts and reviewed full-text articles. Two authors extracted data related to study characteristics, methodology, subjects, and results.
Results:
Fifty-one studies were included. More than half were qualitative or mixed methods studies. Few interventional studies examined objective outcomes. More than half of studies examined instructions for equipment (eg, tracheostomies). Common issues related to access, care coordination, and stress/anxiety. Facilitators included accounting for family context and using health literacy-informed strategies.
Limitations:
No randomized trials met inclusion criteria. Several groups (eg, oncologic diagnoses, NICU patients) were not examined in this review.
Conclusions:
Multiple factors affect comprehension of and adherence to discharge instructions for CMC. Several areas (eg, appointments, feeding tubes) were understudied. Future work should focus on design of interventions to optimize transitions.
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