Perceptions and Barriers to Utilisation of Primary Health Care Services among 1,010 households in Health District IV, Lagos State.

Hospital discharge is a vulnerable transition in the care continuum, particularly for patients leaving emergency and psychiatric settings, where unresolved questions and limited support can affect safety and subsequent healthcare use [,]. Studies have shown that many patients leave the hospital or ED with an incomplete understanding of follow-up plans, medication changes, and warning signs, which can influence their ability to manage care at home [,]. These communication gaps have been associated with unanswered concerns, missed appointments, medication nonadherence, and preventable return visits to acute care settings [-]. Psychiatric populations face additional challenges related to complex treatment needs, community coordination, and barriers to outpatient engagement, which place them at elevated risk for early readmission [,]. Structured post-discharge communication has been proposed as a strategy to address these gaps. Post-discharge telephone follow-up refers to structured telephone contact initiated by a clinician after hospital discharge to reconcile medications, reinforce discharge instructions, identify emerging complications, and confirm follow-up appointments; such contact is generally considered early when completed within 24-72 hours of discharge, with 48-72 hours being the most commonly applied window [-]. Systematic reviews of discharge communication interventions have reported improvements in patient satisfaction, self-management, and understanding of treatment plans []. Early work demonstrated that most patients contacted by telephone within two to three days of discharge had questions about self-care that were not addressed during hospitalization []. Subsequent studies have linked telephone follow-up with greater clarity of medication instructions and more reliable completion of follow-up appointments []. Large cohort studies have also reported reductions in 30-day readmission among patients who received a timely discharge call, including a study of more than 30,000 patients that found a significant reduction in readmission risk when outreach was completed within 14 days []. Integrated health systems implementing nurse-led scripted follow-up programs within 72 hours have similarly reported lower seven-day and 30-day readmission rates among patients successfully contacted []. Automated telephone programs extend these efforts by offering structured outreach at scale and have demonstrated high reach across age groups, including older adults []. In automated models, programs typically use interactive voice response (IVR) technology to place pre-scheduled calls that deliver a standardized, branching script: patients confirm their identity; respond to prompts about symptoms, medication adherence, and appointment status using the keypad or voice; and are automatically escalated to a live nurse or care coordinator when responses indicate a clinical concern or unmet need. In nurse-led models, a dedicated nurse navigator places a direct call to each discharged patient and works through a similar script, confirming patient identity, reviewing discharge instructions and medications, screening for new or worsening symptoms, verifying that follow-up appointments are scheduled, and answering patient questions. Work in older adults has shown strong engagement with automated calls and frequent questions regarding follow-up planning and appointment scheduling []. Transitional care programs that incorporate multiple follow-up calls have been associated with higher completion of recommended post-discharge activities, suggesting that call frequency and call quality influence effectiveness []. In psychiatric settings, multistage evaluations emphasize the importance of consistent communication, patient and family education, team-based coordination, and clear processes for addressing emerging concerns during the transition period []. Beyond clinical outcomes, the transition from hospital to home is also a key determinant of patient satisfaction. Prior work has shown that patients report continued, often unmet, education needs after discharge and that the perceived importance of discharge topics increases once patients are home, indicating greater readiness to engage with follow-up communication during this period [].