Planning for Hospital Discharge for Older Adults in Uganda: A Qualitative Study Among Healthcare Providers Using the COM-B Framework

Abstract

Judith Owokuhaisa,1 Jeremy I Schwartz,2,3 Matthew O Wiens,4,5 Pius Musinguzi,6 Godfrey Zari Rukundo7 1Faculty of Medicine, Department of Physiotherapy, Mbarara University of Science and Technology, Mbarara, Uganda; 2Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda; 3Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; 4Institute for Global Health, British Colombia Children’s Hospital, Vancouver, British Columbia, Canada; 5Department of Anaesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada; 6Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; 7Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, UgandaCorrespondence: Judith Owokuhaisa, Email [email protected]: Proper discharge planning enhances continuity of patient care, reduces readmissions, and ensures safe and timely transition from health facility to home-based care. The current study aimed at exploring the healthcare providers’ perspectives of discharge planning among older adults, with respect to barriers and facilitators within the Ugandan health system.Methods: We conducted a qualitative exploratory study that used one-on-one interviews (Additional file 1) to describe individual perspectives of healthcare providers in their routine clinical care setting. The study included medical doctors (including consultants and physicians), nurses and physiotherapists directly involved in providing care to older adults. We conducted 25 in-depth interviews among healthcare providers for older adults with non-communicable diseases. The audio-recorded interviews were transcribed verbatim. Data were manually organized using a framework matrix guided by the COM-B domains (capability, opportunity and motivation) as the broad themes and sub-themes (physical and psychological capability, social and physical opportunity, reflective and automatic motivation) that influence behavior change (discharge planning).Results: Discharge planning was facilitated by availability of discharge forms, continuous medical education and working experience. The barriers to discharge planning were understaffing, workload/insufficient time, lack of discharge planning guidelines, lack of multidisciplinary approach and congested inpatient wards. Both barriers and facilitators were at various levels of healthcare service delivery such as patient, caregiver, healthcare provider, health facility and policy levels.Conclusion: Barriers to discharge planning spread across all levels of healthcare service delivery, but they can be addressed by enhancing the facilitators. This calls for a multi-level action to ensure adequate and quality patient care during and after hospitalization.Keywords: discharge planning, barriers, facilitators, COM-B framework

Keywords

• discharge planning
• barriers
• facilitators
• com-b framework