Home hospitalization of the acute patient: a new approach to care

Pediatric hospitalization at home (HAH) aims to provide the patient and his family with an alternative to conventional hospitalization, safely and effectively, improving the quality of life of the patient and his family. The most frequent pathologies in HAH in pediatric acute patients are acute respiratory pathology and bacterial infections that require parenteral antibiotic therapy. The success of an acute patient home hospitalization program relies on the proper selection of patients and exhaustive training of caregivers, as well as good communication and coordination between the different services and levels of care involved.

[Coordination between primary care and a geriatrics service, 20 years later]

OBJECTIVE

To describe the evolution of the care and coordination activity of a specialized hospital team (Geriatric Home Care-AGD team) in support of Primary Care (PC) for the care of geriatric patients.

LOCATION

Health-5 area of the Community of Madrid.

PARTICIPANTS, INTERVENTIONS AND MAIN MEASUREMENTS

Evaluation of patients attended at home at the request of PC by AGD, in 1997-1999 and twenty years later, in 2017-2019. Sociodemographic, clinical, functional and mental variables were recorded. Also care data such as time to first visit, average length of stay, origin and destination of patients, reason for consultation and main reason for disability.

RESULTS

524 patients (58% of the total) requested from AP in 1997-1999 and 1196 (72.2% of the total) in 2017-2019 were attended. Currently we show an older patient, more physically and mentally disabled, with a higher prevalence of geriatric syndromes and greater social fragility. Dementia has increased as the main reason for incapacity, with an increase in Comprehensive Geriatric Assessment and clinical control as the main reasons for referral.

CONCLUSIONS

in our setting, after 20 years, AGD continues to be an important support for PC in the complex approach to frail elderly patients confined to their homes, who are increasingly vulnerable from a clinical, functional, cognitive and social point of view. It contributes to the management of geriatric syndromes, deprescription, direct hospital admissions when needed without having to go to the emergency department, and a decrease in institutionalization, facilitating the maintenance of the patient at home.

[Amyotrophic lateral sclerosis (ALS) from the perspective of Primary Care. Epidemiology and clinical-care characteristics]

Amyotrophic Lateral Sclerosis (ALS) is a rare disease in primary care (PC), it represents a challenge for the family doctor, especially in home care.

OBJECTIVE

To know the incidence and prevalence of ALS in an area of ??PA management, the clinical characteristics and use of health resources.

DESIGN

Observational study.

LOCATION

PC-Direction Costa de Ponent, South Metropolitan Health Region, Barcelona, Catalonia, Spain.

PARTICIPANTS

Patients with ALS ≥18 years diagnosed until 03/01/2017. Main measurements Age, sex, characteristics: form of appearance (spinal, bulbar, others), interval between onset of symptoms and diagnosis, percutaneous gastrostomy carriers, ventilation non-invasive or invasive. Identification in PC as a Complex Chronic Patient or with palliative needs (CCP). Inclusion in home care programs (PAD). Model of attention hospitable.

RESULTS

81 patients, mean age 65.6 years (± 11.7), men 49.4%. Shape of onset: spinal 69%, bulbar 21%, another 4%. Interval between the onset of symptoms and diagnosis 12 months. Identified as a CCP 13.6%, 29 patients (35.8%) included in PAD. Attended in comprehensive hospital model 79 patients (97.5%). Prevalence 6.1/100,000 inhabitants in 2017. Annual incidence between 1.2 cases/100,000 inhabitants/year in 2012 and 3.5 cases/100,000 inhabitants/year in 2016.

CONCLUSIONS

The use of percutaneous gastrostomy in ALS favors the identification as CCP or with palliative needs and inclusion in PAD. The use of non-invasive ventilation favors inclusion in PAD. The incidence and prevalence data for ALS are higher than those described above in the same area. Early identification is necessary of these patients in the chronic care models in PC teams.

Feasibility study of abdominal ultrasound using hand-held devices in homecare services

BACKGROUND AND OBJECTIVES

The miniaturisation and portability of ultrasound devices allow the family doctor to apply them in areas such as the patient's home. The present study aims to prove that performing an abdominal ultrasound in the home of frail patients is feasible, decreases the delay in care, and reduces diagnostic uncertainty.

PATIENTS AND METHODS

Case-control study. A sample of 59 patients was studied: 30 cases and 29 controls. A descriptive analysis of the case group was carried out and the delay variable was compared between both groups.

RESULTS

A relevant and significant reduction, up to 10 times lower, was observed in the delay between the ultrasound performed in homecare compared those performed in the hospital. Of the patients, 73.4% only required clinical follow-up by their physician. In those patients who required other complementary tests or referrals, the definitive diagnosis was in complete agreement with the results of the ultrasound performed in homecare.

CONCLUSIONS

The implementation of ultrasound in homecare services is feasible and provides relevant clinical benefits for the patient and increases the resolution capacity of the professional.

The emotional experience of nurses in the Home Hospitalization Unit in palliative care: A qualitative exploratory study

OBJECTIVE

To explore the emotions experienced by the nurses of a Home Hospitalization Unitas a result of their work role.

METHOD

A qualitative exploratory study was carried out with a phenomenology approach toexplore people's experiences and inner-life experiences. The participants were 9 nurses workingin the home hospitalization unit. An analysis of qualitative content was undertaken. Units ofmeaning were grouped into 13 codes that, in turn, were classified into 4 categories, emotionaldimension, beneficial and distressing aspects, daily working life and personal life.

RESULTS

Nursing professionals working in palliative care suffer continuous exposure to traumaticsituations, although they also report feeling satisfactory emotions that compensate for momentsof distress. Having resources such as training in self-care and emotional regulation, as well associal support seems to be key to providing quality care and avoiding the onset of compassionfatigue.

CONCLUSIONS

Maintaining psychosocial well-being in the workplace is crucial for palliative care nurses to be able to undertake their work in the best possible way.

[Does primary care intervention have an impact in the place of death for patients in a palliative care program?]

Objetivos

Conocer si existe relación entre el lugar de fallecimiento y el proveedor de cuidados: equipo de atención primaria (EAP), equipo de soporte atención paliativa domiciliaria (ESAPD) o ambos. Identificar otras variables que pueden influir en el lugar de fallecimiento.

Diseño

Estudio descriptivo observacional retrospectivo.

Emplazamiento

Tres centros de salud, Dirección Asistencial Sureste, Comunidad de Madrid.

Participantes

Pacientes mayores de 18 años con episodio A.99.01 (paciente con necesidad de cuidados paliativos), según la codificación CIAP2, activo en su historia clínica informatizada (AP-Madrid) desde enero de 2016 hasta diciembre de 2018 (n = 499). No cumplieron criterios de inclusión 224 pacientes.

Mediciones y resultados principales

Se incluyeron 275 pacientes, la edad media fue de 78 años. El 80,4% (n = 221) tenían enfermedad oncológica. El 67,6% (n = 186) pertenecían al ámbito urbano. Existían diferencias significativas entre el lugar de fallecimiento y el equipo proveedor de cuidados: fallecieron en domicilio el 23,1% (n = 6) en seguimiento por EAP, el 14,5% (n = 10) en seguimiento por ESAPD y el 29,4% (n = 53) con seguimiento conjunto (p < 0,0001). Fallecieron en domicilio el 20,8% (n = 46) de pacientes oncológicos y el 42,6% (n = 23) no oncológicos (p < 0,0001). El 26,5% (n = 63) de los fallecidos en domicilio tenían cuidador principal y el 16,2% (n = 6) no lo tenían (p < 0,0001). Fallecieron en domicilio el 34,8% (n = 31) del ámbito rural y el 20,4% (n = 38) del ámbito urbano (p < 0,007).

Conclusiones

Los resultados avalan que el seguimiento conjunto aumenta el porcentaje de fallecimientos en domicilio.

The emotional experience of nurses in the Home Hospitalization Unit in palliative care: A qualitative exploratory study

OBJECTIVE

To explore the emotions experienced by the nurses of a Home Hospitalization Unit as a result of their work role.

METHOD

A qualitative exploratory study was carried out with a phenomenology approach to explore people's experiences and inner-life experiences. The participants were 9nurses working in the home hospitalization unit. An analysis of qualitative content was undertaken. Units of meaning were grouped into 13 codes that, in turn, were classified into 4 categories, emotional dimension, beneficial and distressing aspects, daily working life and personal life.

RESULTS

Nursing professionals working in palliative care suffer continuous exposure to traumatic situations, although they also report feeling satisfactory emotions that compensate for moments of distress. Having resources such as training in self-care and emotional regulation, as well as social support seems to be key to providing quality care and avoiding the onset of compassion fatigue.

CONCLUSIONS

Maintaining psychosocial well-being in the workplace is crucial for palliative care nurses to be able to undertake their work in the best possible way.

[Mortality and use of healthcare resources in elderly patients in Seville: Differences between institutionalised patients and those included in a home care program]

OBJECTIVES

Society is ageing, and as a consequence, the population with increased frailty and comorbidity is growing. The aim is to analyse the mortality and its potential factors, as well as the use of healthcare resources in elderly patients, and to study the differences between institutionalised patients and those included in a home care program.

MATERIALS AND METHODS

An observational, longitudinal and prospective cohort study was conducted in Seville during 2016. The study subjects consisted of 1314 elderly patients (1061 institutionalised and 253 at home). The variables studied included mortality and its potential factors, and the use of healthcare resources.

RESULTS

No differences were found in mortality between institutionalised and home care program patients (RR=1.044; 95% CI; 0.74-1.46; P=.799). The leading cause of death was circulatory diseases followed by respiratory diseases. Among the factors explaining the mortality, it is important to highlight: age, dependency and admissions in the hospital or the emergency department. The patient's functional independence is associated with a higher survival rate. Differences were found between both groups in the number of calls to the Critical Care and Emergency Services (P=.022) or the primary care doctor (P<.001) and in the hospital admissions (P<.001), the first 2differences being higher in home care program patients, and the latter in institutionalised patients.

CONCLUSIONS

There are no differences between groups either in the mortality or in the cause of death. Age, functional dependency and admissions in the hospital are factors which explain the mortality. The use of healthcare resources is higher in patients at home.

[Differences between institutionalized patients and those included in a home care program in Seville]

Objetivo

Conocer las características y las diferencias clínicas entre pacientes institucionalizados y los de programas de atención domiciliaria.

Diseño

Estudio observacional descriptivo transversal multicéntrico.

Emplazamiento Sevilla, 2016.

Participantes

Un total de 1.857 pacientes ancianos (1.441 institucionalizados y 416 en domicilio).

Mediciones

Las variables estudiadas fueron: sexo, edad, estado civil, apoyo familiar, patologías, criterios de pluripatología y fármacos. Se valoraron el estado funcional y el cognitivo mediante las escalas de Barthel, Lawton-Brody y Pfeiffer.

Resultados

Un 71,40% fueron mujeres. Estadísticamente el hecho de estar institucionalizados o vivir en el domicilio se relaciona con las siguientes patologías y categorías: esquizofrenia (p < 0,001), HTA (p = 0,012), DM (p = 0,001), FA (p< 0,001) y neoplasias (p = 0, 012), A1 (p = 0,012), A2 (p < 0,001), B1 (p < 0,001), B2 (p = 0,002), C (p < 0,001), E1 (p < 0,001), E3 (p = 0,01), F2 (p < 0,01), G2 (p = 0,024) y H (p = 0,005). El promedio del índice de Barthel de la muestra fue de 49,1 ± 34,45 (IC 95%: 47,49-50,7), el de Lawton-Brody en domicilio fue de 2,33 ± 2,49 y en institucionalizados, de 1,59 ± 2,12. La media de la escala de Pfeiffer fue de 4,93 ± 3,53.

Conclusiones

Se asocia con la institucionalización el deterioro cognitivo, consecuencia de posibles patologías neurológicas (categoría E3) y psiquiátricas. Por el contrario, no se asocia con la comorbilidad del paciente, puesto que es muy elevada en pacientes en situación de atención domiciliaria con mejores estados de independencia funcional y cognitivo.

Psychiatric Home Hospitalization Unit of the Hospital del Mar. A crisis resolution and home treatment team in Barcelona

INTRODUCTION

Although home hospitalization has begun to develop widely in recent years there is a notable lack of studies. The following study includes data from the Psychiatric Home Hospitalization Unit of the Hospital del Mar (HADMar). This program has been running for 2years and takes place in a socio-demographically depressed area in Barcelona. It receives patients from community and hospital services. Monitoring is limited in time and at discharge patient are referred to the ambulatory unit.

MATERIAL AND METHODS

All patients visited from 2015 to the present time were selected. A total of 135 patients were included in the sample. A qualitative descriptive study was carried out in order to define the socio-demographic characteristics. The severity of symptoms, suicidal risk and changes in the functionality were considered as clinical outcomes.

RESULTS

The mean age of patients was 44.6 years and there were no gender differences. A total of 26 patients had a history of suicidal attempts and 11.1% lived alone; 51.1% were diagnosed with a psychotic disorder. The mean GEP score for the severity of the psychiatric symptoms was 2.39 and the mean risk of suicide was 0.49. There is an increase in the EEAG score from admission to discharge, which means an improvement in the functionality of patients.

CONCLUSIONS

The results obtained in our study are consistent with previous results. Home crisis intervention teams have proved to be an alternative to traditional hospitalization. However, more studies are needed to support these results.

Empathy, loneliness, burnout, and life satisfaction in Chilean nurses of palliative care and homecare services

INTRODUCTION

Empathy has been described as an essential competence of healthcare professionals who are working in palliative care and homecare services. In these services, usually accompanied by a high risk of physical and emotional burnout, empathy can play an important role in the improvement of occupational wellbeing. The aim of this study was to confirm the role of empathy in the prevention of loneliness and burn out, and in the promotion of life satisfaction.

METHODS

In 2016, an observational study was carried out in Chile with professional nurses who were working in palliative care and homecare services. Empathy with the patients, loneliness, life satisfaction, and burnout were measured using psychometric scales. Correlation analyses were applied to confirm relationships among the elements measured.

RESULTS

In a sample of 64 participants, positive correlations were confirmed between empathy and life satisfaction (P = 0.40; p = 0.003), and between empathy and professional experience (P = 0.29; p = 0.04). On the other hand, inverse correlations were confirmed between empathy and burnout (P = -0.38; p = 0. 01), and between empathy and loneliness (P = -0.41; p = 0.004).

CONCLUSIONS

These findings confirm the important role that empathy plays in the prevention of loneliness and burnout, and in the promotion of life satisfaction. Evidence found suggests that empathetic abilities can be improved by the professional experience.

[Determining factors in the sedation of geriatric and oncology patients treated at home]

INTRODUCTION

Sedation, used as a therapeutic measure in the field of Palliative Care, continues to present difficulties for many professionals in its management and indications. Is varied existing literature in this regard, often exclusive cancer patients. Our objective is to analyse the characteristics of patients attended by a Home Care Support Team who required sedation compared to non-sedated patients, for possible determining factors for its use that could help in decision-making.

METHOD

A prospective analytical study conducted in Barbastro (Huesca) from September 2007 to February 2011. The study population are patients referred to the Home Care Support Team of Barbastro.

MAIN VARIABLES

Age, sex, medical history, symptoms, previous and current Barthel, Karnofsky, primary caregiver, previous drugs, drugs after intervention, sedation yes/no.

RESULTS

Required sedation 16.6% (n=106) of the cases (N=638). Sedated patients were younger, with no differences in sex, and the large majority (83%) were oncology patients. The presence of metastases showed no differences in need for sedation. Sedated patients have an increased functional impairment, determined by Barthel index decreased and a worse Karnofsky. Sedated patients showed increased frequency of uncontrolled symptoms, except psychomotor agitation, a fact determined by the medications used pre- and post-intervention.

CONCLUSIONS

The presence of neoplastic disease, marked with existence of functional decline, and uncontrolled clinical need for certain medications to control symptoms may determine the need for sedation at the end of the process, above other factors such as patient comorbidity.

[The use of social healthcare resources and informal care characteristics care of immobilised homecare patients]

OBJECTIVE

To describe the use of social healthcare resources by immobilised patients and informal care characteristics and the level/degree of satisfaction with home care services.

METHOD

Descriptive observational study carried out in primary care. The target group were 369 randomly selected immobilised home care patients in the area of Albacete, Spain. The variables included were: socio-demographic data of the patient and carer; the use of social healthcare resources; perceived social support (DUKE-UNK questionnaire); family function (APGAR questionnaire); nursing care and home care services satisfaction (SATISFAD 10 questionnaire).

RESULTS

66.9% of immobilised homecare patients have high dependency and 18.6% have bedsores. The majority of informal carers are women (83.1%) with an average of 57.7 years of age (DE 15.1). The average intensity of care is 15.7 hours per day (DE 8.5) and the average length of care is 5 years. The average number of visits from nurses per month is 2.1 (DE 2.1), although this measurement is higher in patients with bedsores or multiple diseases. The most widely used social health care resources are telephone care (34.2%) and home care (20.3%), for which 65.6% of immobilised homecare patients receive dependency benefits. Overall satisfaction with home care is of a high degree.

CONCLUSION

Musculoskeletal disorders is the main reason for immobilisation in home care patients. Most informal carers are older women. The length and intensity of care is high and the main support comes from healthcare professionals. Patients make limited use of social healthcare resources.

[Transferable skills of healthcare professionals in providing homecare in chronically ill patients]

Objetivo

Determinar, a partir de los análisis de los profesionales de atención domiciliaria, el grado de relevancia de las competencias no técnicas de esos profesionales dedicados a la atención de pacientes con enfermedades crónicas.

Diseño

Investigación cuanti-cualitativa realizada en 2 fases: la 1.^a entre noviembre de 2010 y marzo de 2011 y la 2.^a entre diciembre de 2012 y agosto de 2013.

Emplazamiento

Región Sanitaria de Barcelona ciudad.

Participantes

En la primera fase, 30 profesionales pertenecientes a 6 equipos de atención domiciliaria (3 del ámbito de la atención primaria y 3 del ámbito hospitalario). En la 2.^a fase, 218 profesionales pertenecientes a 50 equipos de atención primaria (EAP) y a 7 programas de atención domiciliaria y equipos de apoyo sanitario y social (PADES).

Método

Muestreo intencional en la 1.^a fase y aleatorio en la 2.^a. Se emplearon escalas tipo Likert y grupos focales.

Resultados

A partir de la identificación de 19 categorías competenciales en la 1.^a fase del estudio, se establecieron, en la 2.^a fase, 3 metacategorías competenciales: atención integral centrada en el paciente, organización interprofesional y entre niveles asistenciales y competencia relacional.

Conclusiones

Es necesario favorecer y garantizar las relaciones profesionales entre niveles asistenciales, la continuidad asistencial, la concepción biopsicosocial y la atención holística al paciente y a su entorno, contemplando emociones, expectativas, sentimientos, creencias y valores de pacientes y familiares.

Es imprescindible el diseño e implementación de formación en competencias transversales en el ámbito de cada centro, a través de metodologías didácticas activas y participativas.

[Are domiciliary care patients receiving adequate thromboprophylaxis?]

INTRODUCTION

The study aims to determine the percentage of patients treated at home with an indication of prophylaxis of thromboembolic disease (TED) according to the PRETEMED guidelines and whether they receive such prophylaxis.

MATERIALS AND METHODS

A cross-sectional descriptive study was conducted in Segovia Palace Health Centre (Madrid).

INCLUSION CRITERIA

to be included in the domiciliary care protocol.

EXCLUSION CRITERIA

terminal patient, hospitalised or surgery in the last 3 months. The variables used include, age, sex, duration of domiciliary care, mobility, anticoagulant or antiplatelet treatment and reason, and associated and precipitating factors to calculate the risk of TED according to the PRETEMED guidelines, and if they receive such prophylaxis, by reviewing computerised medical records and meeting with the staff responsible.

RESULTS

The study included a total of 187 patients, of whom 81% were women There was a significant differences in mean age by sex (men, 76.91 years, 95% CI; 72.59-81.24, and women, 86.72 years, 95% CI; 72.59-81.24, P<.05). Almost two-thirds (65%) walked in the home. There were 3.7% patients who had an indication for receiving prophylaxis, but did not receive it, although 85.8% of them were on anticoagulants or antiplatelet therapy for other reasons.

CONCLUSIONS

Most patients in domiciliary care have a low baseline risk of developing a TED episode in our study. There should be more emphasis placed on the prophylaxis of TED in acute medical episodes in which patients with slightly elevated risk may increase the likelihood of TED. Observational studies should be conducted to study the baseline risk and the subsequent development of TED in the population receiving home care.