Randomised controlled trial comparing hospital at home care with inpatient hospital care. I: three month follow up of health outcomes

Shepperd, Sasha; Harwood, Diana; Jenkinson, Crispin; Gray, Alastair; Vessey, Martin; Morgan, Patrick

doi:10.1136/bmj.316.7147.1786

Cited by 184 publications

(160 citation statements)

References 16 publications

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“…Home care can provide several advantages for patients and caregivers. In several studies, home care was as effective as hospital care and resulted in fewer hospitalisations, decreased pain, improved quality of life, increased performance status, and greater patient satisfaction (Vinciguerra et al, 1986;Ventafridda et al, 1989;Hughes et al, 1992;Shepperd et al, 1998;MacIntyre et al, 2002).…”

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confidence: 99%

Zoledronic acid significantly improves pain scores and quality of life in breast cancer patients with bone metastases: a randomised, crossover study of community vs hospital bisphosphonate administration

et al. 2005

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Zoledronic acid significantly improves pain scores and quality of life in breast cancer patients with bone metastases: a randomised, crossover study of community vs hospital bisphosphonate administration Patients with bone metastases from breast cancer often experience substantial skeletal complications -including debilitating bone pain -which negatively affect quality of life. Zoledronic acid (4 mg) has been demonstrated to reduce significantly the risk of skeletal complications in these patients and is administered via a short, 15-min infusion every 3 weeks, allowing the possibility for home administration. This study compared the efficacy and safety of zoledronic acid administered in the community setting vs the hospital setting in breast cancer patients with X1 bone metastasis receiving hormonal therapy. After a lead-in phase of three infusions of 4 mg zoledronic acid in the hospital setting, 101 patients were randomized to receive three open-label infusions in the community or hospital setting, followed by three infusions in the opposite venue (a total of nine infusions). The Brief Pain Inventory (BPI) and the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 (EORTC QLQ-C30) were used to assess potential benefits of zoledronic acid therapy. At study end, analysis of the BPI showed significant reductions in worst pain (P ¼ 0.008) and average pain in the last 7 days (P ¼ 0.039), and interference with general activity (P ¼ 0.012). In each case, there were significantly greater improvements in pain scores after treatment in the community setting compared with the hospital crossover setting for worst pain (P ¼ 0.021), average pain (P ¼ 0.003), and interference with general activity (P ¼ 0.001). Overall global health status showed a significant median improvement of 8.3% (P ¼ 0.013) at study end. Physical, emotional, and social functioning also showed significant overall improvement (P ¼ 0.013, 0.005, and 0.043, respectively). Furthermore, physical, role, and social functioning showed significantly greater improvements after treatment in the community setting compared with the hospital crossover setting (P ¼ 0.018, 0.001, and 0.026, respectively). There was no difference between hospital and community administration in renal or other toxicity, with zoledronic acid being well tolerated in both treatment settings. These data confirm the safety and quality-of-life benefits of zoledronic acid in breast cancer patients with bone metastases, particularly when administered in the community setting.

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Zoledronic acid significantly improves pain scores and quality of life in breast cancer patients with bone metastases: a randomised, crossover study of community vs hospital bisphosphonate administration

et al. 2005

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“…Se trata, por tanto, de proporcionar asistencia sanitaria especializada en el hogar del paciente cuya situación clínica hace que se requieran tratamientos de rango hospitalario que, de otro modo, implicarían su ingreso en una planta de hospitalización convencional (2).…”

Section: Introductionunclassified

Ingresos en hospitalización a domicilio directamente desde el servicio de urgencias: una alternativa eficaz y segura

Santamariña

2018

Hosp Domic

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Objetivo: Analizar el perfil de pacientes con patología infecciosa que ingresan en HaD tras captación en Urgencias, soporte y calidad asistencial.Método: Estudio observacional retrospectivo. Variables: características del paciente, infección, tratamiento, parámetros de hospitalización e indicadores de calidad.Resultados: Incluidos 255 pacientes con edad media 71 años (48.63% varones; 51.37% mujeres) e índice medio de Charlson 4.91. Diagnósticos más frecuentes: infección urinaria (25.10%) y respiratoria (24.71%), sin identificación microbiológica en 62.75%. Aislamiento más frecuente: E.coli (21.32%) documentándose 10.20% bacteriemia y 14.51% criterios de sepsis. Todos necesitaron antibioterapia parenteral con media 6.5 días, siendo más empleados carbapenems (34.31%). Estancia media en Urgencias 21 horas y en HaD 7 días. Se registraron 9.41% de complicaciones obteniéndose tasa de reingreso 2.75%.Conclusiones: Tras estancia corta en Urgencias es posible el manejo eficaz de infecciones con criterios variables de gravedad y alta comorbilidad, dando el soporte necesario desde HaD, sin aumentar complicaciones ni reingresos.

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“…named contacts, home visits, ongoing support, 24 hour access). 8,10,11,14,24 The need for trusted professionals supporting self-care and coordinating services resonates strongly with work exploring the boundary between self-care and professional care. 25 Other design issues reflect traditional service delivery boundaries in the UK setting (e.g.…”

Section: Interpretation Of Findings In Relation To Previously Publishmentioning

confidence: 99%

“…4,7 Thus, the development of an 'anticipatory care' service which prevents COPD exacerbationsand hence hospitalisation -could reduce pressure on secondary care services and improve patient outcomes, and enable patients to stay in their own home. 8 Evidence supports home care as a cost-effective alternative to hospital care to prevent admissions or support early discharge [9][10][11] but, to the best of our knowledge, there have been no studies of anticipatory interventions targeted at supporting COPD patients before first exacerbation other than those focusing mainly on pulmonary rehabilitation. 12 Given suboptimal attendance and high patient drop-out rates from pulmonary rehabilitation, 13 it is critical to look at other methods of anticipatory care such as ways to optimise treatment to control symptoms and hence delay or reduce first admissions.…”

Section: Introductionmentioning

confidence: 99%

A qualitative study of stakeholder views of a community-based anticipatory care service for patients with COPD

Cleland

Moffat

Small

2012

Primary Care Respiratory Journal

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Randomised controlled trial comparing hospital at home care with inpatient hospital care. I: three month follow up of health outcomes

Abstract: Objectives: To compare hospital at home care with inpatient hospital care in terms of patient outcomes.

Cited by 184 publications

References 16 publications

Zoledronic acid significantly improves pain scores and quality of life in breast cancer patients with bone metastases: a randomised, crossover study of community vs hospital bisphosphonate administration

Zoledronic acid significantly improves pain scores and quality of life in breast cancer patients with bone metastases: a randomised, crossover study of community vs hospital bisphosphonate administration

Ingresos en hospitalización a domicilio directamente desde el servicio de urgencias: una alternativa eficaz y segura

A qualitative study of stakeholder views of a community-based anticipatory care service for patients with COPD

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