A pre-discharge project--does GP willingness equal involvement?

Abstract

OBJECTIVE: To compare GPs' willingness to participate in a GP pre-discharge project as measured by a survey, with actual participation rates. To identify the characteristics of GPs likely to make a pre-discharge visit to frail, aged inpatients admitted under the care of a geriatrician. METHOD PRE-IMPLEMENTATION GP SURVEY: Survey of a random sample of 100 GPs from the Central Sydney area using a standardised questionnaire. PRE-DISCHARGE VISIT PROJECT: Information on actual participation rates and GPs who declined to make a pre-discharge visit was obtained from an audit of Division of General Practice records. Information on Patient characteristics was obtained from patient interviews and medical records. The survey was conducted at the Balmain Hospital and Concord Repatriation and General Hospitals located within the Central Sydney Area Health Service. The subjects were GPs practising in central Sydney and patients admitted under the care of a geriatrician at Balmain and Concord Hospitals. RESULTS: Twenty-nine per cent of GPs reported that they were willing to undertake visits without remuneration and 71% reported they were willing to make a pre-discharge visit if remunerated. Fifty-three per cent of GPs actually complied with a request to make a remunerated pre-discharge visit. This was 18% less than the rate determined by the survey. GPs were less likely to make a visit if they were solo practitioners and not members of the Division. Patients who were more dependent, as measured by total Barthel's score, and those from nursing homes were less likely to receive a visit. CONCLUSION: GP surveys may overestimate participation rates in Division projects. In reality, it appears difficult for GPs to accommodate pre-discharge visits in a general practice routine and the offered remunerations may not be adequate compensation for time lost when undertaking a pre-discharge visit. Lastly, some GPs may not see a benefit in visiting more dependent patients.