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Patient-Physician Communication at Hospital Discharge and Patients' Understanding of the Postdischarge Treatment Plan

David R. Calkins, MD, MPP; Roger B. Davis, ScD; Peggy Reiley, RN, MSc; Russell S. Phillips, MD; Katherine L. C. Pineo; Thomas L. Delbanco, MD; Lisa I. Iezzoni, MD, MSc
Arch Intern Med. 1997;157(9):1026-1030. doi:10.1001/archinte.1997.00440300148014.
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Background:  The quality of discharge planning is an important determinant of patient outcomes following hospital discharge. Patients often report inadequate discussion prior to discharge regarding major elements of the postdischarge treatment plan, including medication and daily activities.

Objective:  To determine whether this apparent lack of communication might be the result of differing perceptions on the part of patients and physicians regarding the patients' understanding of the treatment plan.

Methods:  We surveyed 99 patients and their attending physicians. All patients had been discharged recently from an academic medical center with the diagnosis of acute myocardial infarction or pneumonia. We asked both patients and physicians about time spent prior to discharge discussing the postdischarge treatment plan and the patients' understanding of this plan. McNemar test was used to determine whether responses of patients and physicians differed.

Results:  Physicians reported spending more time discussing postdischarge care than did patients (P=.10). Physicians believed that 89% of patients understood the potential side effects of their medications, but only 57% of patients reported that they understood (P<.001). Similarly, physicians believed that 95% of patients understood when to resume normal activities, while only 58% of patients reported that they understood (P<.001).

Conclusions:  Physicians overestimate patients' understanding of the postdischarge treatment plan. Steps should be taken to improve communication about postdischarge treatment.Arch Intern Med. 1997;157:1026-1030


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