Discharge Follow-Up of Patients in Primary Care Does Not Meet Their Care Needs: Results of a Longitudinal Multicentre Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The study addresses an important topic concerning the continuity of care for patients after hospital discharge. The study's results highlight significant points requiring further observation and action in the current healthcare system. They underscore the need for better coordination of care, especially for the most vulnerable patients. The recommendations in the article can contribute to improving the quality of healthcare and reducing inequalities in access to health services.

Despite the positive assessment of the manuscript, I have a few comments and questions:

1. Introduction – It could be significantly more concise and shorter.
2. Data Source – Where did the authors obtain information on whether the individuals included in the study were alive on the day of inclusion?
3. Patient Differentiation – Did the authors differentiate patients based on the type of ward they were hospitalized in (medical or surgical), the mode of admission (emergency or planned), and the procedures performed (surgery, diagnostics)? These variables could significantly impact the need for continuity of care after discharge.

Author Response

Response to Reviewer 1 Comments
Thank you very much for the comments and time spent reading this work.
Please find below our responses to the reviewers’ comments. All the changes
introduced are indicated in the document (marked in red).

1. Introduction – It could be significantly more concise and shorter.
   You are right, we have made improvements to the text following your instructions.
2. Data Source – Where did the authors obtain information on whether the individuals included in the study were alive on the day of inclusion? 
   It was the DRAGO-AP computerized system itself that informed us if the patient was deceased. We have included this explanation in the text to improve understanding.
3. Patient Differentiation – Did the authors differentiate patients based on the type of ward they were hospitalized in (medical or surgical), the mode of admission (emergency or planned), and the procedures performed (surgery, diagnostics)? These variables could significantly impact the need for continuity of care after discharge. 

You are right. Due to the characteristics of our database, we were unable to obtain this data. We agree with you that it would be very interesting, and we will take it into account for future research.

Reviewer 2 Report

Comments and Suggestions for Authors

Comments for author File: Comments.pdf

Author Response

Thank you very much for the comments and time spent reading this work.
Please find below our responses to the reviewers’ comments. All the changes introduced are indicated in the document (marked in red).
Comments 1
This section is quite difficult to follow.
In my opinión, for greater fluidity and understanding of the manuescript, I would divide the materials and methods section into several subsections: e.g. Study desing, Population and Sample, Data Collection Instruments, and Statistical analysis.
You are right, we have modified it in the text following your instructions.

Reviewer 3 Report

Comments and Suggestions for Authors

Longitudinal retrospective study examining follow-up care of complex and vulnerable patients following hospital admission with appropriate methods and analyses. Please add study design to the title. The authors propose that more vulnerable patients need earlier and more frequent follow-up by their GP and community nurse. This hypothesis needs more justification. They find that the number of consultations increased with increasing complexity. However, they find that more complex patients were most likely to receive a home visit from the community nurse, which is unsurprising and that they were less likely to be seen by the GP, presumably because of difficulty attending the health centre. The authors argue that this is not meeting their care needs and is an example of the inverse care law. I am not convinced by this argument. Community nurses my well be the most appropriate clinician to see patients at home who have recently been in hospital, particularly if there are continuing nursing needs. There are opportunity costs for GPs on home visits as they can see fewer patients than in the health centre. We do not know what healthcare needs these patients have and as their recent needs might have been met in their recent in-patient admission. The question remains as to the most appropriate way to manage these patients and Kaiser Permanente propose usual care with support for low risk patients (labelled chronic in Table 2); assisted care or care management for high risk and intensive or case management for the highly complex. Just looking at number of consultations with the GP and the mode of consultation does not adequately describe whether the care needs of patients with high complexity have been met. I would value a discussion on the best way of achieving “intensive or case management” for the highly complex group, following hospital discharge which would require co-ordination between community services, secondary care of the elderly services in hospital and primary care.

Minor points

Throughout the article change psychical (which refers to paranormal abilities) to psychological

Table 1 Rather than “Need greater follow-up at discharge due to biological condition”, perhaps state “Greater complexity at discharge due to…”

Line 151  and Table 2 clarify what chronic patients mean. You are referring to the Kaiser Permanents pyramid so perhaps refer to them as lower risk with chronic conditions

line 199 what does MF refer to?

Comments on the Quality of English Language

Throughout the article change psychical (which refers to paranormal abilities) to psychological

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

I am happy with the responses and changes