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Exploring healthcare providers’ perspectives of the paediatric discharge process in Uganda: a qualitative exploratory study
  1. Brooklyn Nemetchek1,
  2. Asif Khowaja2,
  3. Anthony Kavuma3,
  4. Olive Kabajaasi3,
  5. Alex Olirus Owilli1,
  6. J Mark Ansermino4,5,
  7. Susan Fowler-Kerry1,
  8. Shevin T Jacob3,6,
  9. Nathan Kenya-Mugisha3,
  10. Jerome Kabakyenga7,
  11. Matthew O Wiens5,8
  1. 1 College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  2. 2 School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
  3. 3 Walimu, Mbarara, Uganda
  4. 4 Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
  5. 5 Center for International Child Health, BC Children's Hospital, Vancouver, British Columbia, Canada
  6. 6 Department of Clinical Services, Liverpool School of Tropical Medicine, Liverpool, UK
  7. 7 Maternal, Newborn, and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda
  8. 8 Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
  1. Correspondence to Dr Matthew O Wiens; mowiens{at}outlook.com

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.

  • Pediatrics
  • Patient Discharge
  • Qualitative Research
  • Uganda

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors BN carried out data analysis and interpretation, drafted the initial manuscript, critically reviewed and revised the manuscript, approved the final manuscript as submitted, and agreed to be accountable for all aspects of the work. AKa contributed to data analysis, interpretation and drafting of initial manuscript, critically reviewed and revised the manuscript, approved the final manuscript as submitted and agreed to be accountable for all aspects of the work. AK carried out data acquisition, contributed to data interpretation, critically reviewed and revised the manuscript, approved the final manuscript as submitted, and agreed to be accountable for all aspects of the work. OK carried out data acquisition, contributed to data interpretation, critically reviewed and revised the manuscript, approved the final manuscript as submitted and agreed to be accountable for all aspects of the work. AOO contributed to study design and data interpretation, critically reviewed and revised the manuscript, approved the final manuscript as submitted and agreed to be accountable for all aspects of the work. JMA contributed to data interpretation, critically reviewed and revised the manuscript, approved the final manuscript as submitted and agreed to be accountable for all aspects of the work. SF-K contributed to data interpretation, critically reviewed and revised the manuscript, approved the final manuscript as submitted and agreed to be accountable for all aspects of the work. STJ contributed to data interpretation, critically reviewed and revised the manuscript, approved the final manuscript as submitted, and agrees to be accountable for all aspects of the work. NK-M contributed to study design and data interpretation, critically reviewed and revised the manuscript, approved the final manuscript as submitted and agreed to be accountable for all aspects of the work. JK contributed to study design and data interpretation, critically reviewed and revised the manuscript, approved the final manuscript as submitted and agreed to be accountable for all aspects of the work. MOW contributed to study conceptualisation and design, coordinated and supervised the project, contributed to data interpretation and drafting of initial manuscript, critically reviewed and revised the manuscript and approved the final manuscript as submitted, and agreed to be accountable for all aspects of the work.

  • Funding This research was funded by Grand Challenges Canada.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained from the research ethics boards at the University of British Columbia (H18-00403) and Mbarara University of Science and Technology (MUREC 1/7).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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