Patients' views on their discharge from follow up in outpatient clinics: qualitative study

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Abstract
Objectives: To discover the views of patients about their discharge from outpatient clinics, to detect any change in these perceptions over time, and explore how the discharge process might be improved for the patient. Design: A qualitative study comprising in-depth or semistructured interviews with patients 2 weeks and 3 months after discharge from an outpatient clinic. Subjects: 45 patients who had attended outpatient clinics on three or more occasions. Setting: Five general medical outpatient clinics from a Manchester provider trust. Main outcome measures: Aspects of the discharge consultation valued by patients included confidence that the doctor knew and understood their case; clarity of the discharge process; an explanation of the reasons for discharge; information about treatment, future care, and the mechanism for re-referral; and being seen by doctors who sought their views and allowed time for questions and reflection. Conclusions: Patients' views about their discharge changed over time and varied in relation to several factors, which included patients' perceptions of the discharge process, patients' expectations, the way in which the outpatient clinics were organised, and patients' relationships with, and confidence in, their general practitioners. Patients being discharged from outpatient clinics value a clear message that they are being discharged, information about their condition and care, recognition of their views, and time to ask questions Patients are usually realistic about the care that their general practitioner can provide. Specialists could make use of this knowledge in deciding when to discharge a patient The grade of the doctor at the discharge consultation has no bearing on differences in patients' views of discharge Written information about their condition and how to look after themselves would help patients and reduce communication difficulties between hospitals and general practitioners

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