Heart Failure and Chronic Obstructive Pulmonary Disease Multimorbidity at Hospital Discharge Transition: a Study of Patient and Carer Experience

Objectives: The main objective of our study was to explore the experiences of heart failure (HF) and chronic obstructive pulmonary disease (COPD) multimorbid patients and their carers on hospital discharge. Secondary objectives included identification of gaps in the health care of multimorbidity and optimal solutions from patients and carers’ perspectives.
Methods: Mixed-methods were applied to collect data using patient self-completion questionnaire from an adopted version of the HCAHPS survey and in depth interviews. Participants were recruited from two cardiology and respiratory wards at a large regional hospital in England, and all had a multimorbidity diagnosis of COPD and HF.
Results: 14 out of 29 (48%) completed HCAHPS questionnaires were returned. Overall, nurses scored better (84%) than doctors (64%) in listening to patients. There were problems in communication about medication with 73% not aware of the reasons for new medication and 64% never been informed of their side effects.
In-depth interviews were carried out with 6 patients and 5 carers in the home setting one to two weeks following hospital discharge. Interviewees’ descriptions of their experiences on hospital discharge fell into four main themes: clarity of information, communication, continuity of care after discharge and issues with medication.
Conclusion: Our study showed that gaps and delays in communication between healthcare professionals and poor discharge documentation continue to be recurring issues in caring for patients with multimorbidity of HF and COPD. It further points to the need for a comprehensive, coordinated and integrated care that incorporates patients and carers preferences in order to improve the outcomes for multimorbidity.