Discharge planning at rural and small town hospitals: how is it accomplished?

Within Canadian society inequities exist in health status and health care provision. Residents of rural, isolated areas tend to fare worse when compared with their urban counterparts. Much of the research about health care provision is written for and from urban centres. However, the research in this thesis is not urban-based and addresses an issue important to rural communities. The research explores how discharge planning is accomplished at rural and small town acute care hospitals within the Northern Interior Health Region of British Columbia. A descriptive qualitative methodology was used to address the research question. Fifteen semi-structured interviews were conducted at five different small town locations within the Northern Interior Health Region of British Columbia. At each location interviews were conducted with three key informants about the discharge planning practices utilized at the local hospital. These key informants were a practicing physician, a nurse employed at the hospital, and a recently discharged patient. Analysis of the interview transcripts revealed twenty-four themes. Eleven of these themes suggest that the rural and small town environment exerts a positive influence on discharge planning processes, practices, and outcomes. Thirteen of the emergent themes suggest that the rural and small town context negatively influences discharge planning. A comparative analysis across key informant groups found similarities across the groups with physician and nurse responses being most similar. The themes derived from the patient interviews were more unique. Results suggest that improving outcomes for patients discharged from rural and small town hospitals will require augmentation and coordination of community based supports such as home care nursing, mental health services, and social services. Increased accessibility to specialist resources and more direct involvement of patients in planning for their post-hospital care needs are also indicated.