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Year : 2018  |  Volume : 7  |  Issue : 2  |  Page : 120-122

Role of medical and psychiatric social workers in improving follow-up care in surgical settings: Medical and psychiatric social work perspective

Neurosurgery Unit, Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

Date of Web Publication2-May-2018

Correspondence Address:
Dr. Raju Birudu
Department of Psychiatric Social Work, Neurosurgery Unit, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijhas.IJHAS_142_1

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How to cite this article:
Birudu R, Reddy KN. Role of medical and psychiatric social workers in improving follow-up care in surgical settings: Medical and psychiatric social work perspective. Int J Health Allied Sci 2018;7:120-2

How to cite this URL:
Birudu R, Reddy KN. Role of medical and psychiatric social workers in improving follow-up care in surgical settings: Medical and psychiatric social work perspective. Int J Health Allied Sci [serial online] 2018 [cited 2023 Dec 10];7:120-2. Available from: https://www.ijhas.in/text.asp?2018/7/2/120/231689


Medical and psychiatric social workers (MPSWs) play an imperative role in the multidisciplinary team.[1] MPSWs are unique and clinically contribute to the patient and family care by interviewing people, psychosocial need assessment, field investigation, providing psychosocial interventions, resource mobilization and increase the follow-up rates of patients, and ensure coping skills in caregivers from the holistic care point of view.[2],[3],[4] They help the treating team in identifying the underlying socioeconomic-cultural beliefs to arrive at the accurate diagnosis.[5]

Most of the time, neurosurgeons witnessed and raised concerns with respect to postoperative condition and follow-up status of neurosurgically ill patients and care received at home after discharge. With regard to know this information, neurosurgeons make referrals to MPSWs, sometimes for research and academic purposes on selected cases. Most of the time, postoperative status of surgical patients is neglected by health-care professionals in general. In addition, there are very minimal studies focused to understand the postoperative conditions of surgical patients. Therefore, the objective of the study was:

  1. To explore the reasons for not adhering to regular follow-up or missed/delayed follow-up for more than twice after surgical interventions received at neurosurgical units
  2. To depict the importance of home visits in improving the follow-up care in surgical conditions.

Patients (n = 100) suffering from brain tumor, traumatic brain injury (TBI), and spinal cord injury (SCI) referred by neurosurgeons to MPSWs at outpatient department, neurosurgical unit were purposively chosen and contacted over phone. Referred patients' contact details such as age, gender, address, and phone numbers were collected from e-hospital records from the institute with prior permission of unit head, head of the Department of Neurosurgery, and medical record section.

Patients who missed two (6 months) continuous follow-ups or more were contacted over phone. The phone calls were made by MPSWs working in the neurosurgical unit. MPSWs had phone interviews with patients or caregivers/family members with the help of predesigned questions focused to elicit the reasons for delayed follow-up. All answers received by patients and caregivers/family members were immediately documented in separate Excel sheets. MPSWs send reminders regarding follow-up dates to patients on a regular basis as a part of clinical work in collaboration with neurosurgical team; thus, no ethical clearance was obtained from the institute.

Reasons reported over phone on delayed follow-up by patients, caregivers, or family members were converted into nominal data (yes/no). Frequency and proportions and mean (standard deviation) were calculated for nominal and categorical variables and continuous data, respectively. Data was analyzed using free R software i386 3.2.4 revised version (2012), Freedom Foundation, USA.

Results showed that 69% (n = 69) of male and 31% (n = 31) of female patients were referred by neurosurgeons, subsequently contacted over phone. Patients' average age was 50.28 ± 7.66 years. Physical disability or impaired functionality in day-to-day activities (87%); increased roles, responsibilities, psychological strain, and burden among caregivers (84%); inadequate transport facility (80%); financial constraints (62%); poverty (62%); and long distance (50%) were reported as causes for missed follow-up.

Reasons for delayed/missed or not adhering to regular follow-up after surgical interventions among patients suffering from central nervous system disorders (brain tumor, TBI, and SCI) were not much explored in India. Thus, the current study findings hold the significance. The findings highlighted that physical disability, impaired functionality, multiple roles and responsibilities, caregiver strain and burden, financial constraints, long distance, poverty, and inadequate transport facilities were the main reasons for not adhering to regular/missed/delayed follow-up. This finding goes in line with the previous studies which suggested that morbidity and mortality among surgical patients are generally high. Physical disability, functional impairment, cognitive dysfunction, fatigue, mood disorders, changes in personality, financial hardship, increased dependency, and caregiver burden may act as barriers for follow-up.[6],[7],[8] Thus, to improve the follow-up care of surgical patients and to address the psychosocial issues in caregivers, the following ways can be used. The ways are suggested based on clinical experience working with neurosurgical patients and their families:

  1. Conducting predischarge counseling for all patients and psychosocial interventions to needy surgical patients and their caregivers compulsorily by MPSWs during hospitalization
  2. Reminding follow-up dates given by the treating team periodically over phone or writing letters to patients and their family members
  3. Ensuring that eligible disability patients access welfare benefits from government and access research benefits if they are already part of the research study
  4. Liasoning with local health-care workers in the community such as accredited social health activist workers and health educators
  5. Networking with local nongovernmental and governmental organizations for home care and long-term care
  6. In addition, frequent scheduled messages through mobile phone and social media such as WhatsApp/Facebook/email can be utilized in case clients/family members are familiar with modern technology and Internet use
  7. Creating team of follow-up counselors trained in doing home visits (MPSWs including multidisciplinary team).

Home visit is used as a basic tool in the social work profession. The home visits make the social work profession unique from other professions. For patients who are bed bound, wheel chaired, critically ill, and for those from low socioeconomic background, home visit must be made mandatory to ensure better care after surgical interventions. Home visits not only help to gain the trust on treating team but also help to understand the real social milieu of the patient and his/her family environment. Our previous home visit gave an in-depth understanding on socioeconomic condition, postoperative status, resources available in the community, and family dynamics that changed due to illness of brain tumor which in turn paved way to design better and timely psychosocial interventions for the indexed patient and the family.[4] However, over a period of time, home-based care services are reduced and a dearth of literature persist on this issue on how to do a home visit.[9],[10] Therefore, to fill this literature gap as well as to improve the follow-up care, we suggest essential steps to be taken in doing safe home visits based on our clinical experience as shown in [Table 1].
Table 1: Preparatory plan and guidelines for home visits for neurosurgically ill people and their family members

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There are several ways to remind follow-up dates, appointments of patients, caregivers, family members but not limited to only few as mentioned above. To conclude socioeconomic conditions, home and environmental barriers cannot be appraised sitting in the hospital setup. Thus, home visits are recommended to increase the follow-up rates, psychosocial well-being, and quality of life of patients and their families in the surgical setting.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Shrivastava SR, Shrivastava PS, Ramasamy J. Medical social worker: Strengthening linkages between the hospital and the community. Int J Health Syst Disaster Manag 2014;2:130.  Back to cited text no. 1
Raju B, Reddy K. Are counseling services necessary for the surgical patients and their family members during hospitalization? J Neurosci Rural Pract 2017;8:114-7.  Back to cited text no. 2
[PUBMED]  [Full text]  
Raju B, Lukose S, Raj P, Reddy K. Clinically providing psycho-social care for caregivers in emergency and trauma care setting: Scope for medical and psychiatric social workers. Int J Crit Illn Inj Sci 2016;6:206-10.  Back to cited text no. 3
[PUBMED]  [Full text]  
Raju B, Lukose S, Reddy NK. Does lack of resources within the family starting point to social exclusion for persons with brain cancer? J Neurosci Rural Pract 2016;7:S125-6.  Back to cited text no. 4
Nottingham C, Dougall R. A close and practical association with the medical profession: Scottish medical social workers and social medicine, 1940-1975. Med Hist 2007;51:309-36.  Back to cited text no. 5
Leligdowicz A, Katwere M, Piloya T, Ronald A, Kambugu A, Katabira E, et al. Challenges in diagnosis, treatment and follow-up of patients presenting with central nervous system infections in a resource-limited setting. Mcgill J Med 2006;9:39-48.  Back to cited text no. 6
Catt SL, Anderson JL, Critchley GR. Patients' and staff's experiences of multidisciplinary follow-up for high-grade glioma after radical radiotherapy. Psychol Health Med 2011;16:357-65.  Back to cited text no. 7
Shukla D, Devi BI, Agrawal A. Outcome measures for traumatic brain injury. Clin Neurol Neurosurg 2011;113:435-41.  Back to cited text no. 8
Naylor MD, Brooten D, Campbell R, Jacobsen BS, Mezey MD, Pauly MV, et al. Comprehensive discharge planning and home follow-up of hospitalized elders: A randomized clinical trial. JAMA 1999;281:613-20.  Back to cited text no. 9
Lyter SC, Abbott AA. Home visits in a violent world. Clin Superv 2007;26:17-33.  Back to cited text no. 10


  [Table 1]


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