title: A randomised trial deploying a simulation to investigate the impact of hospital discharge letters on patient care in general practice.
abstract: OBJECTIVE
  To determine how the timing and length of hospital discharge letters impact on the number of ongoing patient problems identified by general practitioners (GPs).
  
  
  METHODS
  GPs were randomised into four groups. Each viewed a video monologue of an actor-patient as he might present to his GP following a hospital admission with 10 problems. GPs were provided with a medical record as well as a long or short discharge letter, which was available when the video was viewed or 1 week later. GPs indicated if they would prescribe, refer or order tests for the patient's problems.
  
  
  METHODS
  Setting Primary care. Participants Practising Australian GPs. Intervention A short or long hospital discharge letter enumerating patient problems. Outcome measure Number of ongoing patient problems out of 10 identified for management by the GPs. Randomisation 1:1 randomisation. Blinding (masking) Single-blind.
  
  
  RESULTS
  Numbers randomised 59 GPs. Recruitment GPs were recruited from a network of 102 GPs across Australia. Numbers analysed 59 GPs. Outcome GPs who received the long letter immediately were more satisfied with this information (p<0.001). Those who received the letter immediately identified significantly more health problems (p=0.001). GPs who received a short, delayed discharge letter were less satisfied than those who received a longer delayed letter (p=0.03); however, both groups who received the delayed letter identified a similar number of health problems. GPs who were older, who practised in an inner regional area or who offered more patient sessions per week identified fewer health problems (p values <0.01, <0.05 and <0.05, respectively). Harms Nil.
  
  
  CONCLUSIONS
  Receiving information during patient consultation, as well as GP characteristics, influences the number of patient problems addressed.
  
  
  BACKGROUND
  ACTRN12614000403639.
authors.affiliation: Department of Medical Education, Curtin University, Perth, Western Australia, Australia.
authors.forename: Moyez
authors.initials: M
authors.lastname: Jiwa
authors.affiliation: Faculty of Health Science, School of Public Health, Curtin University, Perth, Western Australia, Australia.
authors.forename: Xingqiong
authors.initials: X
authors.lastname: Meng
authors.affiliation: Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia.
authors.forename: Carolyn
authors.initials: C
authors.lastname: O'Shea
authors.affiliation: Discipline of General Practice, University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Parker
authors.initials: P
authors.lastname: Magin
authors.affiliation: School of Business, University of Western Sydney, Parramatta, New South Wales, Australia.
authors.forename: Ann
authors.initials: A
authors.lastname: Dadich
authors.affiliation: Department of Medical Education, Curtin University, Perth, Western Australia, Australia.
authors.forename: Vinita
authors.initials: V
authors.lastname: Pillai
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D005791:Patient Care; D010351:Patient Discharge; D016544:Patient Simulation; D016037:Single-Blind Method
keywords: PRIMARY CARE