a1 Associate Research Fellow, Primary Care Research Group, Peninsula College of Medicine & Dentistry, University of Exeter, Exeter, UK
a2 Senior Lecturer in Primary Care, Primary Care Research Group, Peninsula College of Medicine & Dentistry, University of Exeter, Exeter, UK
a3 General Practitioner, The Surgery, Marlpits Lane, Honiton, Devon, UK
a4 Honorary Senior Clinical Research Fellow, Primary Care Research Group, Peninsula College of Medicine & Dentistry, University of Exeter, Exeter, UK
a5 Urgent Care Lead Manager, Devon Doctors Ltd, Unit 10 Manaton Court, Manaton Close, Matford, Exeter, Devon, UK
Aim To work with service users and providers to optimise the design and implementation of handover forms to support the transfer of information between daytime and out-of-hours primary care services for patients with palliative care needs.
Background There is a need for improved informational continuity between daytime and out-of-hours primary care services for patients with palliative care needs. Research suggests that while handover forms are vital to ensure continuity of care, they remain underused for such patients. Audit work in an out-of-hours primary care service in South West England identified that their current system of handover forms was underused.
Methods An action research study consisting of two phases was undertaken. In phase one, the views of general practitioners and nurses working in the out-of-hours and daytime primary care services (29 health professionals) in Devon (population c.1.4 million) and patients with palliative care needs and their carers (8 participants) were investigated using qualitative interviews and focus group methods. Participants’ views on the content and use of handover forms, and of the systems supporting their generation were sought. In phase two, additional feedback from the health professional stakeholder groups was collected and collaborative work undertaken with the out-of-hours service to implement recommendations emerging from the qualitative research.
Findings Respondents identified variable use of handover forms and inconsistent practice in terms of: who was responsible for generating and updating forms; when and where they were discussed in primary care; the criteria used to define which patient needed a form; and the information forms should contain. There was uncertainty about how handover forms were used by the out-of-hours service and concerns about incomplete access to forms for certain groups of staff. An action plan to improve the existing system was developed. This included distribution of educational materials (desktop guide, newsletter) to key stakeholders, and the modification of information systems to facilitate the updating of messages and the accessibility of electronic records for previously under-served staff.
(Received July 06 2010)
(Revised November 08 2011)
(Accepted November 09 2011)
(Online publication February 07 2012)
c1 Correspondence to: Dr Suzanne H. Richards, Peninsula College of Medicine & Dentistry – Primary Care, University of Exeter, Smeall Building, St Luke's Campus, Magdalen Road, Exeter EX1 2LU, United Kingdom. Email: firstname.lastname@example.org