title: Transferring information to an out-of-hours primary care service for patients with palliative care needs: an action research study to improve the use of handover forms.
abstract: OBJECTIVE
  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.
authors.affiliation: Primary Care Research Group, Peninsula College of Medicine & Dentistry, University of Exeter, Exeter, UK.
authors.forename: Anthea
authors.initials: A
authors.lastname: Asprey
authors.forename: Suzanne H
authors.initials: SH
authors.lastname: Richards
authors.forename: Christine
authors.initials: C
authors.lastname: Wright
authors.forename: Clare
authors.initials: C
authors.lastname: Seamark
authors.forename: David
authors.initials: D
authors.lastname: Seamark
authors.forename: Jane
authors.initials: J
authors.lastname: Moxon
mesh_terms: D039602:After-Hours Care; D003266:Continuity of Patient Care; D004739:England; D017144:Focus Groups; D058005:General Practitioners; D006302:Health Services Research; D006801:Humans; D009740:Nursing Staff; D010166:Palliative Care; D062209:Patient Handoff / Q000458:organization & administration*; D011320:Primary Health Care; D036301:Qualitative Research