Haringa, D.P.M. (2012) Transmurale samenwerking en communicatie In de aanpak van ondervoeding bij de geriatrische patiënt. thesis, Medicine.
Full text available on request.Abstract
Background: Malnutrition is a major threat to the independence and quality of life of hospitalised frail older people. Because hospital admissions are getting shorter the recovery of patients mainly takes place outside the hospital. Improving and maintaining the nutritional status is increasingly becoming the responsibility of the general practitioner (GP). Appropriate medical transfer of information on the nutritional status of patients is therefore crucial in the continuity of treatment of malnutrition after discharge. Previous research has shown that the transfer of information on malnutrition is inadequate. Methods: This study consisted of three parts: 1. a retrospective study of geriatric discharge letters concerning information on malnutrition before and after standardisation of the letter format; 2. A survey among GPs concerning the quality of the information on malnutrition in geriatric discharge letters and; 3. a consensus study among general practitioners using a Delphi method aiming to reach agreement regarding the content and timing of the transmission of information on the nutritional status between geriatrician and GP at discharge. Results Part 1: The discharge letters of 87 patients from before the change of format, and of 98 patients from after the change in format were studied. There was no change in the number of times the diagnosis malnutrition was mentioned in the discussion (21 and 31 times, in resp. 2010 and 2011) and the conclusion (13 en 19 times in resp. 2010 and 2011) of the discharge letter after change of format. In addition, there was no difference in the number of advices given to the general practitioner concerning the interventions for malnutrition (both years 7 times) Part 2: GPs thought the information on malnutrition was unclear without a difference between years (2010 unclear 57% versus 2011 unclear 52%, p=1.000). GPs were usually not satisfied/not dissatisfied with the information give in the discharge letter (44% in 2010 versus 36% in 2011 (p=0.707)). Only 5 GPs (7.8%) had recorded malnutrition as a diagnosis in their computerised registration system. Part 3: The Delphi study showed that GPs want to receive written information about malnutrition in the discharge letter, with the mentioning of the diagnosis in the sections discussion and conclusion, with a description of the causes of malnutrition, the agreements made with patient and caregiver, and the advices on interventions including who does what. Discussion: This study shows that standardisation of the exchange of information concerning malnutrition in the geriatric discharge letter did not improve the transmission , thus still falls short. Compared to studies investigating discharge letters of internists, nutritional status was mentioned more frequently in geriatric discharge letters. GPs found geriatric discharge letters regarding malnutrition unclear and recorded the diagnosis in less than 10% in their computer system. GPs want to be informed in writing about the diagnosis malnutrition and have a particular need for information about the aftercare. Conclusion: Other measures are needed to ensure adequate continuation of the treatment of malnourished geriatric patients who are discharged from hospital. Perhaps the dietician can play a leading role in the transfer of information concerning malnutrition. Based on the results of the consensus study, we know which information the general practitioner wishes to receive. In addition, educating GPs on the causes, consequences and treatment of malnutrition in the elderly could be of value.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and Asselt, Dr. D.Z.B. van and Klinische Geriatrie, Medisch Centrum Leeuwarden |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:50 |
| Last Modified: | 25 Jun 2020 10:50 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1131 |
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