Journal Information
Vol. 56. Issue 8.
Pages 479-480 (August 2020)
Vol. 56. Issue 8.
Pages 479-480 (August 2020)
Editorial
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Home hospitalization in pulmonology: Efficient management and high patient satisfaction
Hospitalización a domicilio en neumología: gestión eficiente con elevada satisfacción de los pacientes
Visits
...
María-Teresa García Sanza,
Corresponding author
maytegsanz@gmail.com

Corresponding author.
, Liliana Doval Oubiñab, Francisco Javier González Barcalac
a Servicio de Urgencias, Hospital do Salnés, Vilagarcía de Arousa, Pontevedra, Spain
b Servicio de Hospitalización a Domicilio, Hospital do Salnés, Vilagarcía de Arousa, Pontevedra, Spain
c Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
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New healthcare models have recently been developed to optimize care and streamline costs in the treatment of patients with respiratory disease. Hospital at home (HH) and early supported discharge (ESD), often evaluated jointly in meta-analyses, avoid admissions and shorten the average length of stay in selected patients, while offering a quality of care similar to that provided by conventional hospitalization (CH), along with lower mortality and readmission rates.1–4 This approach also increases patient well-being and reduces the risk of nosocomial infection.5 According to a recent study, the combination of HH and telemonitoring would allow most COPD patients to be treated at home, decreasing emergency visits and reducing the number of patients admitted to CH by 60%.4 HH and ESD are safe and effective not only for the treatment of acute COPD, but also for other patients with respiratory symptoms, such as decompensated heart failure,6 respiratory infections in patients with neuromuscular disease,7 or pulmonary thromboembolism in hemodynamically stable patients.8 Studies conducted in several countries with different health systems and different HH/ESO organizational structures agree that these solutions are less costly than CH, even in older patients with more serious exacerbations or worse baseline status.2–5,9 The degree of satisfaction, speed of recovery, and quality perceived by both caregivers and patients treated with HH and ESD is high: a high percentage indicated that they would prefer this type of admission for future exacerbations.2–4,10

However, although the advantages of HH/ESD are manifold and this approach is recommended by clinical guidelines as an alternative to CH,11–14 it is rarely selected as an admission modality. Dismore et al. recently identified possible causes10: reasons given by patients include fear of being alone during the night, delayed medical care compared to CH in the event of complications, and perceived stigma associated with receiving support from the social services, while some are concerned about privacy issues associated with the presence of strangers in their home. In contrast, some patients see admission to CH as an opportunity to interact with other people or to try to quit smoking. Furthermore, it seems that clinicians continue to believe that CH is safer for their patients and gives caregivers the opportunity for a break to avoid burnout. The development of referral protocols with clear criteria agreed on by all the departments involved would undoubtedly help to reduce the apparent misgivings surrounding this care modality, and underline the clear advantages that it provides for both patients and family members and for the health system.

Several HH/ESD models that differ in terms of infrastructure, professionals involved, number of visits made, telephone support, and access to services such as rehabilitation or social support are efficient if clear inclusion criteria are followed, certain health and social welfare conditions are met, and families are supported. Continuing care can be guaranteed if responsibilities are shared between primary care and HH teams, provided chronic and acute needs are clearly differentiated in order to avoid conflicting responsibilities and overlap with services already covered by primary care.

Now it is our turn.

References
[1]
F.J. González-Barcala, A. Pose-Reino, J.J. Paz-Esquete, R. De la Fuente-Cid, L.A. Masa-Vázquez, P. Álvarez-Calderón, et al.
Hospital at home for acute resiratory patients.
Eur J Intern Med, 17 (2006), pp. 402-407
[2]
C. Echevarría, K. Brewin, H. Horobin, A. Bryant, S. Corbett, J. Steer, et al.
Early supported discharge/hospital at home for acute exacerbation of chronic obstructive pulmonary disease: a review and meta-analysis.
[3]
C. Echevarría, J. Gray, T. Hartley, J. Steer, J. Miller, A.J. Simpson, et al.
Home tratment of COPD exacerbation selected by DECAF score: a non-inferiority, randomised controlled trial and economic evaluation.
[4]
M. Miron-Rubio, R. Ceballos-Fernández, I. Parras-Pastor, A. Palomo-Iloro, B.M. Fernández-Félix, J. Medina-Miralles, et al.
Telemonitoring and home hospitalization in patients with chronic obstructive pulmonary disease.
Expert Rev Respir Med, 12 (2018), pp. 335-343
[5]
R. Aimonino, V. Tibaldi, B. Leff, C. Scarafiotti, R. Marinello, M. Zanocchi, et al.
Substitutive “hospital at home” versus inpatient care for elderly patients with exacerbations of chronic obstructive pulmonary disease: a prospective randomized, controlled trial.
J Am Geriatr Soc, 56 (2008), pp. 493-500
[6]
K. Voudris, M. Silver.
Home hospitalization for acute descompensated heart failure: oportunities and strategies for improved health outcomes.
Healthcare (Basal), 6 (2018), pp. 31
[7]
A. Vianello, F. Savoia, E. Pipitone, B. Nordio, G. Gallina, L. Paladini, et al.
Hospital at Home for neuromuscular disease patients with respiratory tract infection: a pilot study.
Respir Care, 58 (2013), pp. 2061-2068
[8]
P.D. Stein, F. Matta, M. Hughes.
National trends in home tratment of acute pulmonary embolism.
Clin Appl Thromb Hemost, 24 (2018), pp. 115-121
[9]
J. Bourbeau, D. Granados, S. Roze, I. Durand-Zaleski, P. Casan, D. Köhler, et al.
Cost-effectiveness of the COPD patient management european trial home-based disease management program.
Int J Chron Obstruct Pulmon Dis, 14 (2019), pp. 645-657
[10]
L.L. Dismore, C. Echevarria, A. van Wersch, J. Goibson, E. Bourke.
What are the positive drivers and potential barriers to implementation of hospital at home selected by low-risk DECAF score in the UK: a qualitative study embedded within a randomised controlled trial.
[11]
British Thoracic Society Guideline Development Group.
Intermediate care-Hospital-at-Home in chronic obstructive pulmonary disease: British thoracic society guideline.
Thorax, 62 (2007), pp. 200-210
[12]
J.A. Wedzicha, P.M.A. Calverley, R.K. Albert, A. Anzueto, G.J. Criner, J.R. Hurst, et al.
Prevention of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline.
[13]
NICE.
Chronic obstructive pulmonary disease in over 16s: diagnosis and management. NG 115.
National Institute for Health and Care Excellence, (2018),
[14]
Guía de Práctica Clínica para el Diagnóstico, Tratamiento de Pacientes con Enfermedad Pulmonar Obstructiva Crónica (EPOC).
Guía Española de la EPOC (GesEPOC). Versión 2017.
Arch Bronconeumol, 53 (2017), pp. S2-64

Please cite this article as: García Sanz MT, Doval Oubiña L, González Barcala FJ. Hospitalización a domicilio en neumología: gestión eficiente con elevada satisfacción de los pacientes. Arch Bronconeumol. 2020;56:479–480.

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