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Impact of Hospital Discharge Follow-Up Calls on Post-Discharge Clinic Attendance in Nigeria

Abstract

Continuity of care after hospital discharge is essential for ensuring that patients understand their treatment plans, attend scheduled follow-up appointments, recognize warning signs, and receive timely medical review when necessary. Failure to attend post-discharge clinic appointments may result in delayed detection of complications, poor treatment adherence, preventable readmissions, and poorer health outcomes. In Nigeria, post-discharge clinic attendance may be affected by limited patient awareness, forgetfulness, transportation difficulties, financial constraints, inadequate communication, poor understanding of follow-up instructions, and weak continuity-of-care systems. Hospital discharge follow-up calls provide a relatively simple communication strategy through which healthcare workers can contact recently discharged patients, remind them about scheduled appointments, clarify discharge instructions, identify emerging health concerns, and encourage timely return to the hospital. Effective implementation of follow-up calls may therefore improve patients' engagement with post-discharge healthcare services. Against this background, this study investigates the impact of hospital discharge follow-up calls on post-discharge clinic attendance in Nigeria. The study will be anchored on the Health Belief Model, Continuity of Care Theory, and the Donabedian Model of Healthcare Quality. The Health Belief Model explains how patients' perceptions of the benefits and importance of follow-up care, perceived barriers, and cues to action may influence their decision to attend scheduled appointments. Continuity of Care Theory emphasizes the importance of coordinated and consistent healthcare interactions across different stages of a patient's healthcare journey, including the transition from hospital admission to community-based or outpatient follow-up. The Donabedian Model explains healthcare quality through structure, process, and outcome, with discharge follow-up calls representing a healthcare process and post-discharge clinic attendance serving as a measurable outcome. Collectively, these theoretical perspectives provide a suitable framework for explaining how hospital discharge follow-up calls may influence post-discharge clinic attendance in Nigeria. The study will adopt a quantitative quasi-experimental research design. The study population will comprise adult patients discharged from selected public and private hospitals in Nigeria who are scheduled for follow-up clinic appointments. A multistage sampling technique will be used to select states, local government areas, hospitals, clinical departments, wards, and eligible discharged patients. Hospital discharge follow-up calls will be assessed using indicators such as whether follow-up calls are provided, timing of the first call after discharge, number and frequency of calls, use of standardized call protocols, appointment reminders, clarification of discharge instructions, assessment of patients' health concerns, identification of warning signs, referral or escalation procedures, documentation of calls, staff responsible for follow-up, and availability of telephone communication systems. Post-discharge clinic attendance will be assessed using indicators such as attendance at the scheduled follow-up appointment, attendance within the recommended timeframe, missed appointments, rescheduling of appointments, time between discharge and follow-up attendance, number of follow-up visits completed, and continuity of scheduled clinical care. Data will be collected using structured questionnaires, hospital discharge records, follow-up call logs, clinic appointment registers, electronic medical records where available, telephone follow-up documentation, and patient records. Descriptive statistics will be used to summarize patients' demographic and clinical characteristics, discharge arrangements, follow-up-call exposure, and clinic attendance patterns. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of discharge follow-up calls on post-discharge clinic attendance. Where a quasi-experimental design is adopted, clinic attendance among patients receiving follow-up calls may be compared with attendance among patients receiving usual discharge care. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that hospital discharge follow-up calls have a significant positive impact on post-discharge clinic attendance in Nigeria. Patients who receive timely and structured follow-up calls are expected to have a higher likelihood of attending scheduled post-discharge clinic appointments than patients who receive routine discharge instructions without telephone follow-up. Appointment reminders may reduce forgetfulness and improve patients' awareness of the importance of follow-up care, while telephone contact may provide an opportunity to clarify instructions and address concerns that could otherwise discourage patients from returning to the hospital. Follow-up calls may also enable healthcare workers to identify emerging complications and direct patients to appropriate services when necessary. However, limited access to reliable telephone services, incorrect patient contact information, staff shortages, inadequate follow-up documentation, patient financial constraints, transportation difficulties, and poor telephone connectivity may limit the effectiveness of follow-up calls. The study therefore expects structured, timely, patient-centred, and adequately monitored hospital discharge follow-up calls to contribute significantly to improved post-discharge clinic attendance in Nigeria. The study is expected to contribute to the literature on hospital discharge follow-up, post-discharge clinic attendance, continuity of care, transitional care, patient follow-up, hospital readmission prevention, healthcare communication, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, state ministries of health, hospital management boards, healthcare administrators, physicians, nurses, pharmacists, patient follow-up teams, health information managers, and policymakers regarding strategies for strengthening continuity of care after hospital discharge. The study will also provide evidence-based recommendations for institutionalizing telephone follow-up programmes, developing standardized discharge call protocols, improving appointment reminder systems, strengthening documentation of follow-up contacts, updating patient contact information, training healthcare workers in post-discharge communication, and integrating telephone follow-up into hospital transitional-care and quality-improvement programmes across Nigeria.

Keywords: Hospital discharge follow-up calls, post-discharge clinic attendance, patient follow-up, continuity of care, transitional care, appointment reminders, discharge planning, healthcare communication, hospital readmission prevention, Nigeria, public health.