Doctors working in the home reduce hospital visits
A new study, in the August edition of the Australian Health Review, the peer reviewed journal of the Australian Healthcare and Hospitals Association, has found that more involvement by doctors in Hospital in the Home (HITH) programs can decrease the need for hospital visits.
“In 1994, Hospital in the Home was introduced in Australia, driven by efforts to improve the efficiency of hospital bed management. HITH can enable patients to remain in a familiar setting, close to family and in their community while they receive treatment,” one of the researchers, Dr Anh Tran, staff specialist, at Werribee Mercy Hospital, said.
“HITH has also been shown to result in lower running costs, less confusion, fewer urinary and bowel complications and decreased hospital-acquired infection.
“The range of conditions treated by HITH and the evidence supporting its efficacy and safety are growing and include cellulitis, deep venous thrombosis (DVT), pulmonary embolism and pneumonia.
“In the common HITH nurse model, nurses administer treatment in the patients’ homes and medical review is undertaken at the parent hospital, after a defined period or when problems arise. Most of the research undertaken to date on HITH is based on this model.
“However, HITH programs with dedicated medical practitioners solely responsible for HITH patients are becoming more common as there is recognition of the need for close medical supervision. Also, hospital reviews may be inconvenient for patients and associated with resource issues for outpatient and emergency departments,” said Dr Tran.
“This study examined the effectiveness of a ‘medical model’, where a doctor visited the patient in their home. It is the first study to report the effect of having doctors directly managing HITH patients with cellulitis and DVT in their own homes.
“Our research showed that this model was associated with significantly decreased HITH length of stay and scheduled or unscheduled hospital reviews and admission rates. The model results in no changes in unexpected post HITH reviews and AE rates. Although it is associated with a greater minor complication rate, most complications were easily managed in the HITH setting.
“Due to these benefits the “medical model” may be associated with some savings in resource utilisation and may reduce the load of public hospitals. However, the use of a doctor may be associated with increased expense and therefore cost–benefit analyses are recommended to assess whether the benefits of this model outweigh the additional cost,” Dr Tran said.
