Discharging psychiatric in-patients back to primary care: A pragmatic randomized controlled trial of a novel discharge protocol

It is imperative that communication between secondary and primary care is optimal at the time of discharge, thereby reducing the risk of relapse and readmission. In a pragmatic randomized controlled trial, 343 patients were randomly allocated to a novel discharge protocol or to conventional discharge. The novel discharge incorporated telephoning the patient's general practitioner (GP) and arranging a GP appointment for that patient. Comparisons were made in terms of readmission within 6 months, mental health status, the speed and frequency of contact with services and appropriate continuation of medication, GPs and psychiatrists mere interviewed to elicit views of the two discharge procedures. There were no differences in mental health status at 1 month, numbers of patients readmitted, speed of contact with primary care, appropriate continuation of medication or absolute numbers of GP appointments. However, patients in the novel discharge group had more GP consultations related to mental health and a smaller proportion had hospital out-patient appointments. Ten (63%) GPs and eight (47%) psychiatrists preferred the novel protocol. The main perceived benefits were increased and up-to-date information received by GPs and the facilitation of contact between care sectors. Reservations were centred upon the practical difficulties of making and receiving telephone calls - the cost per patient of implementing the protocol was £1.14. Thus, useful benefits accrued from the introduction of the novel protocol at little cost and a possible saving in hospital out-patient costs. These advantages might be enhanced if the practical difficulties of implementation can be overcome.