Disease-a-month : DM
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Disease-a-month : DM · Apr 2002
Randomized Controlled Trial Clinical TrialThe impact of follow-up telephone calls to patients after hospitalization.
We studied whether pharmacists involved in discharge planning can improve patient satisfaction and outcomes by providing telephone follow-up after hospital discharge. We conducted a randomized trial at the General Medical Service of an academic teaching hospital. We enrolled General Medical Service patients who received pharmacy-facilitated discharge from the hospital to home. ⋯ Twelve patients (15%) contacted by telephone reported new medical problems requiring referral to their inpatient team. Fewer patients from the phone call group returned to the emergency department within 30 days (10% phone call vs. 24% no phone call, P = 0.005). A follow-up phone call by a pharmacist involved in the hospital care of patients was associated with increased patient satisfaction, resolution of medication-related problems, and fewer return visits to the emergency department.
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Disease-a-month : DM · Apr 2002
Palliative care and the hospitalist: an opportunity for cross-fertilization.
Most US citizens die in acute care hospitals, often in physical pain, without attention to emotional and spiritual suffering. This represents an ethical failure of our current health-care system. The field of palliative medicine aims to address the physical, emotional, and spiritual needs of patients with advanced disease. ⋯ When hospitalists are not selected and trained effectively around palliative care issues, the risks are great. Discontinuity of physicians can lead to miscommunication and misunderstanding (by professionals, patient, and family); disagreement about treatment focus (especially as it relates to a shift from curative to palliative); inappropriate deferring of advance care planning to the hospital setting; and, most worrisome, a lack of expertise in symptom control, communication skills, and attention to patient and family distress and the provision of emotional and spiritual support. This article evaluates the convergence of the 2 fields of palliative medicine and hospitalist medicine and reviews the opportunities for mutual education and improved patient care.
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One key issue in the hospitalist movement is the need for hospitalists to establish rapport and maintain relationships with their patients. Rapport is critical in obtaining a thorough history, and then effectively negotiating the diagnosis and treatment plan with patient and family. ⋯ The importance of the physical setting and of nonverbal skills cannot be underestimated. Rapport-building techniques can be learned but require practice.