Effectiveness of hospital-to-home transitional care interventions and consultation for implementation in Sudan: a scoping review of systematic reviews

Abstract

Background: Hospital discharge is often associated with a lack of continuity resulting in fragmented care, particularly in low-income countries. As there is limited information about interventions in these countries and no study evaluating the effectiveness of hospital discharge interventions, we conducted a scoping review to identify effective hospital-to-home transitional care interventions and explore their applicability in a low-income country (Sudan).

Methods: Our scoping review of systematic reviews and meta-analyses classed interventions as effective, ineffective, undesirable, or uncertain, based on the quality of their evidence and their estimated effects on the following outcomes: readmission rates, mortality, costs, quality of life, and adverse outcomes) and certainty of evidence. Our authors from Sudan used the SUPPORT summary tool to determine if three effective interventions could be implemented in Sudan.

Results: Out of 3,276 articles that were identified, and 72 articles were reviewed, 10 articles has been included in the review. Seven interventions were classified as effective, one as ineffective, and none with undesirable effects. Eight interventions were classified as having an uncertain effect. The effective interventions were composed of home visits, information and communication technology (ICT), case manager models, multidisciplinary teams, and self-management support.

Conclusions: The finding of this study suggested that a combining two to four interventions can improve enhance hospital-to-home transitional care. Effective interventions are composed of home visits, ICT, case manager models, multidisciplinary teams, and self-management support. The implementation of these interventions in Sudan was found to be undermined by contextual factors such as inadequate human resources, telecommunication instability, and inequality in accessibility. These interventions could be tailored based on an in-depth understanding of the contextual factors in low-income countries that influence implementation.

Systematic review registration: https://osf.io/9eqvr/, doi: 10.17605/OSF.IO/9EQVR.

Keywords: chronic disease; hospital discharge; integrated healthcare; low-income country; low-resource setting; primary care; transition of care.

Figure 1

Summary of the scoping review methodology and the used tools.

Figure 2

Study flowchart.

Figure 3

Conceptual diagram represents the possible combination of intervention components for effective interventions for the transition of care from hospital to home. Each field represent sets of interventions, 1, single component intervention; 2, intervention of two components; 3, intervention of three components; 4, intervention of four components; 5, intervention of five components. ICT, information and communication technology.