El informe de alta hospitalaria en atención primaria (I). Análisis de su utilidad

OBJECTIVES: To calculate the number of hospital discharge reports (HDR) received in primary care for determined kinds of patients suffering chronic pathologies who need on-going care. To evaluate whether the reports' contents are of use to the family doctor's monitoring of the patient. DESIGN: Descriptive study. SETTING: Four reformed health districts that share the same referral hospital in the city of Mataró (Barcelona). PATIENTS AND OTHER PARTICIPANTS: 124 patients were discharged in 1996 for pathologies requiring ongoing care in primary care (diabetes, hypertension, chronic obstructive pulmonary disease, cerebral vascular accident, femur fracture and neoplasms). INTERVENTIONS: Systematic comparison of various sections of the HDR with the information in the primary care clinical notes (PCCN). MEASUREMENTS AND MAIN RESULTS: In 12.9% (95% CI, 8.1-18.8%) of the PCCNs examined, there was no record of the HDR. In 76.6% (69.1-84.1%) of the patients studied, the HDR contributed new information on some of the contents reviewed ("useful" HDR). In the remaining 22.6% (15.2-30.0%) the HDR contributed no new information and left out necessary follow-up and monitoring information ("useless" HDR). Nevertheless, in as many as 89.5% (84.1-94.9%) of the patients, the PCCNs recorded some clinically important piece of information or intervention that did not figure in the HDR. This occurred more often in questions of prevention and quality of life (56.5%), special treatment (42.3% of those who needed it), anamnesis (40.3%) and follow-up (31.5%). CONCLUSIONS: Despite the potential importance of HDRs for on-going care of patients discharged from hospital for chronic complaints, and although a high percentage of HDRs reach the general practitioner, their lack of content negates their usefulness in 22.6% or more of cases.