This article offered a few more specific instances of successful follow-up care offered to patients that seem successful in avoiding readmission. Some of the things I talked about in the November 15 post were identified in this article:
Robert Wood Johnson University Hospital in New Brunswick, N.J., has nurses visit high-risk patients at their home within two days of leaving the hospital.This is such an important thing to have available, especially for elderly or less-mobile patients. My mom is going through a really rough time right now and while I was at her chemo appointment with her last week the nurse advised her to talk to the nutritionist as a way of getting some ideas for keeping weight on during the chemo treatments and keeping her energy up. My mom was extremely resistant solely because she HATES going to the hospital and has to go out there practically every week (and often two times during a week) just to get the necessities for her chemo treatments taken care of. The last thing she wants to do is go again to see a nutritionist. So, in the nurse's defense, she said, "how about a phone appointment?" But, my mom also doesn't hear very well, so she hates doing things over the phone. So, a follow up in her home or better yet, during her hour long chemo appointment when she is stuck just sitting there anyways seems like a reasonable accommodation. But, it probably is not going to happen and she will miss out on that information.
I have also noticed the confusion with generic medication names being used versus the licensed medication names. The docs and nurses often refer to the meds by the names the licensed names, while the names on the bottles are the generic names. There usually is a reference, albeit often small, to the licensed name, but it often goes unnoticed. For example, when my mom had her chemo appointment, the nurse told her that for nausea she could take not only her usual dose of her Zofran, but could take an additional dose of Compazine in between the Zofran dose times. When we got back to my mom's I went through her myriad of medicine bottles to pull out the Zofran and Compazine and it took me a really long time because they were both generics and I didn't realize the names would be different. I think a lot of times, my mom doesn't take the Compazine because she can't locate it easily and it isn't something she takes all the time. With my daughter (heart transplant recipient), we always have to answer questions about what she is taking when we go into the clinic or get admitted to the hospital and I often have to ask them for dosages of drugs instead of the names because I don't recognize the names. Our labels are a bit better than my mom's as they will typically say "generic for ______" in the same size type as the generic name, but they are often so long and complicated that I would never recognize them. This, I'm sure, can lead to some confusion in both administering drugs as well as reordering them.
I am not sure what the answer to all of the problems in our health system are, but I do think that the expense of individuals NOT doing their follow up appropriately will be worse than whatever the expense is of figuring out and implementing solutions to some of these problems.