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Exploring healthcare providers' perspectives of the paediatric discharge process in Uganda: a qualitative exploratory study.

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Nemetchek, Brooklyn, Khowaja, Asif, Kavuma, Anthony, Kabajaasi, Olive, Olirus Owilli, Alex, Ansermino, J Mark, Fowler-Kerry, Susan, Jacob, Shevin ORCID: https://orcid.org/0000-0003-2425-9394, Kenya-Mugisha, Nathan, Kabakyenga, Jerome and Wiens, Matthew O (2019) 'Exploring healthcare providers' perspectives of the paediatric discharge process in Uganda: a qualitative exploratory study.'. BMJ Open, Vol 9, e029526.

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Abstract

INTRODUCTION
The burden of childhood mortality continues to be born largely by low-income and middle-income countries. The critical postdischarge period has been largely neglected despite evidence that mortality rates during this period can exceed inpatient mortality rates. However, there is a paucity of data on the paediatric discharge process from the perspective of the healthcare provider. Provider perspectives may be important in the development of an improved understanding of the barriers and facilitators to improving the transition from hospital to home.
OBJECTIVES
To explore healthcare providers' and facility administrators' perspectives of the paediatric discharge process with respect to: (1) current procedures, (2) barriers and challenges, (3) ideas for change, (4) facilitators for change and (5) the importance of discharge planning.
DESIGN
A qualitative exploratory approach using focus groups (14) and in-depth interviews (7).
SETTING
This study was conducted at seven hospitals providing paediatric care in Uganda.
RESULTS
Current discharge procedures are largely based on hospital-specific protocols or clinician opinion, as opposed to national guidelines. Some key barriers to an improved discharge process included caregiver resources and education, critical communication gaps, traditional practices, and a lack of human and physical resources. Teamwork and motivation to see improved paediatric transitions to home were identified as facilitators to implementing the ideas for change proposed by participants. The need for a standardised national policy guiding paediatric discharges, implemented through education at many levels and coupled with appropriate community referral and follow-up, was broadly perceived as essential to improving outcomes for children.
CONCLUSIONS
Although significant challenges and gaps were identified within the current health system, participants' ideas and the identified facilitators provide a significant basis from which change may occur. This work can facilitate the development of sustainable and effective interventions to improve postdischarge outcomes in Uganda and other similar settings.

Item Type: Article
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 320 Child Welfare. Child Health Services.
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WA Public Health > Statistics. Surveys > WA 950 Theory or methods of medical statistics. Epidemiologic methods
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1136/bmjopen-2019-029526
Depositing User: Julie Franco
Date Deposited: 10 Sep 2019 11:22
Last Modified: 12 Sep 2019 13:01
URI: https://archive.lstmed.ac.uk/id/eprint/12414

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