The goal of this cluster randomized controlled trial is to evaluate whether a nurse-led primary health care (PHC) discharge intervention can improve patient activation and primary health care-related outcomes among hospitalized adult patients after discharge.
Hong Kong residents aged ≥18 years
Able to read and communicate in Chinese (Cantonese or Mandarin)
Being hospitalized for more than 24 hours
Stable medical condition upon hospital discharge
Having a history of psychiatric/psychological disease or currently on regular psychotropic medications
Currently participating in other primary healthcare programmes
Parallel
Primary healthcare discharge education
BehavioralThe primary healthcare discharge education begins by identifying priorities to address related to patients' life situations (using the Instrument for Patient Capacity Assessment) and determining the patient's current level of activation (using the Patient Activation Measure). A discharge education guide developed by the research team helps to individualize the teaching according to the patient's priorities and activation level.
specially-designed health education leaflet
Behavioral1. Introduction of the District Health Centres/Expresses; 2. Life Course Preventive Care Plan pamphlet; 3. Provide disease-specific discharge/rehabilitation advice and relevant health education materials with an emphasis on prevention and self-care management; 4. The hospital nurses will help discharge patients download and install the "HA Go" mobile app.
Patient discharge package
BehavioralSubjects in the intervention group will receive the following items with instructions for use upon hospital discharge: 1. Blood pressure monitor 2. Blood glucose test strip 3. Soft ruler to measure weight circumference 4. Resistance bands for simple exercise
usual hospital discharge practice
BehavioralThe control group will receive the usual hospital discharge practice upon discharge.
The primary outcome is the change in the Patient Activation Measure (PAM) between baseline and 3-month follow-up.
The PAM is a 13-item self-report questionnaire to measure patient activation level \[18\]. Patients can go through four levels of activation: (1) disengaged and overwhelmed, (2) becoming aware but still struggling, (3) taking action, and (4) maintaining behaviors and pushing further \[18\].PAM raw score can be calculated by adding all of the responses to the 13 questions \[18\]. This score is then converted into an activation score ranging from 0 = no activation to 100 = high activation using a scoresheet provided by Insignia Health.
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The University of Hong Kong
Lead sponsor
Queen Mary Hospital, Hong Kong
Collaborator
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