ABSTRACT
INTRODUCTION: The experience of an urban Tertiary University Hospital in the design and implementation of Hospital at Home Program (HaHP) integrated in a Department of Internal Medicine and highly coordinated with Medical Services of the Hospital and the Primary Health Care, that contemplates the like main objectives of the promotion of specialized home care medical diseases and the improvement of the coordination with the primary health care. PATIENTS AND METHOD: Systematic collection in all the patients admitted between April 2006 and March 2007 in the HaHP of the following variables: age, gender, service of origin, main diagnosis, Barthel and Charlson index, number of visits per day to doctors and nurses, destination on discharge and medical team. The descriptive statistical analysis was made in April 2007. The results are presented globally and differentiated by teams (internal medicine, respiratory and nutritional support teams). RESULTS: 506 admissions in 390 patients with a mean age of 66.5 (18) years, 53% being women. The Charlson index was 2 (2.2) and the Barthel index 63.5 (40,4). Average stay was 7.9 (8.2) days. The main reasons for admission were the infections and domiciliary intravenous antibiotic therapy in 153 (30.5%) cases, followed by patients with chronic obstructive pulmonary disease or cardiac failure in 107 (21%) cases, and home enteral and parenteral nutrition in 102 (20%) cases. Two hundred (39.5) patients were subsequently controlled by their primary care team after discharger, 241 (47.5) patients were followed-up in the hospital consultations, and 45 (9%) of the patients had to return directly to the hospital. CONCLUSIONS: The creation of a HaHP, for medical diseases, in internal medicine department that is highly coordinated with medical services of the hospital, especially with emergency, respiratory, and nutritional support teams, and with the primary health care, facilitates specialized home care of medical diseases and improves coordination with the primary health care.
Subject(s)
Home Care Services/organization & administration , Primary Health Care/organization & administration , Aged , Female , Hospitals, University , Humans , Male , Prospective Studies , SpainABSTRACT
Introducción. Se presenta la experiencia de un hospital universitario terciario urbano en el diseño e implementación de una unidad de hospitalización a domicilio (UHaD) integrada en un Servicio de Medicina Interna y altamente coordinada con los servicios médicos del hospital y la Atención Primaria de salud del entorno hospitalario, que contempla como principales objetivos la promoción de la atención especializada domiciliaria de patologías médicas y la mejora de la coordinación con la Atención Primaria de salud. Pacientes y métodos. Recogida sistemática en todos los pacientes ingresados entre abril 2006 y marzo 2007 en la UHaD de las siguientes variables: edad, sexo, lugar y servicio de procedencia, diagnóstico principal, índice de Barthel y de Charlson, número de visitas al día de enfermería y médicas, destino al alta y equipo médico responsable. El análisis estadístico descriptivo se realizó en abril de 2007. Los resultados se presentan de forma global y diferenciados por equipos (Medicina Interna, Neumología y soporte nutricional). Resultados. Quinientos seis ingresos que correspondían a 390 pacientes con una edad media de 66,5 (18) años, y un 53% mujeres. El índice de Charlson fue de 2 (2,2) y el índice de Barthel de 63,5 (40,4). La estancia media fue de 7,9 (8,2) días. Los principales motivos de ingreso fueron las infecciones y tratamiento antibiótico por vía intravenosa en 153 (30,5%) casos, las agudizaciones de enfermedad pulmonar obstructiva crónica o insuficiencia cardíaca en 107 (21%) casos y la nutrición enteral o parenteral domiciliaria en 102 (20%) casos. Doscientos (39,5%) pacientes al finalizar el ingreso fueron controlados por sus equipos de Atención Primaria, 241 (47,5%) fueron seguidos en consultas del hospital y 45 (9%) retornaron directamente al hospital. Conclusión. La creación de una UHaD para patologías médicas desde el Servicio de Medicina Interna, altamente coordinada con servicios médicos del hospital, especialmente con Urgencias, Neumología y Soporte Nutricional y con la Atención Primaria del entorno hospitalario, facilita la atención especializada domiciliaria de patologías médicas y mejora la coordinación con la Atención Primaria de salud
Introduction. The experience of an urban Tertiary University Hospital in the design and implementation of Hospital at Home Program (HaHP) integrated in a Department of Internal Medicine and highly coordinated with Medical Services of the Hospital and the Primary Health Care, that contemplates the like main objectives of the promotion of specialized home care medical diseases and the improvement of the coordination with the primary health care. Patients and method. Systematic collection in all the patients admitted between April 2006 and March 2007 in the HaHP of the following variables: age, gender, service of origin, main diagnosis, Barthel and Charlson index, number of visits per day to doctors and nurses, destination on discharge and medical team. The descriptive statistical analysis was made in April 2007. The results are presented globally and differentiated by teams (internal medicine, respiratory and nutritional support teams). Results. 506 admissions in 390 patients with a mean age of 66.5 (18) years, 53% being women. The Charlson index was 2 (2.2) and the Barthel index 63.5 (40,4). Average stay was 7.9 (8.2) days. The main reasons for admission were the infections and domiciliary intravenous antibiotic therapy in 153 (30.5%) cases, followed by patients with chronic obstructive pulmonary disease or cardiac failure in 107 (21%) cases, and home enteral and parenteral nutrition in 102 (20%) cases. Two hundred (39.5) patients were subsequently controlled by their primary care team after discharger, 241 (47.5) patients were followed-up in the hospital consultations, and 45 (9%) of the patients had to return directly to the hospital. Conclusions. The creation of a HaHP, for medical diseases, in internal medicine department that is highly coordinated with medical services of the hospital, especially with emergency, respiratory, and nutritional support teams, and with the primary health care, facilitates specialized home care of medical diseases and improves coordination with the primary health care
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Tertiary Healthcare , Home Care Services, Hospital-Based/organization & administration , Health Care Levels/organization & administration , Hospital Departments/organization & administration , Primary Health Care/organization & administration , Hospitals, University/organization & administration , Nutritional SupportABSTRACT
OBJECTIVE: To study the clinical, therapeutic, and evolutive features in 25 patients with the diagnosis of varicella pneumonia (VP) in the last 15 years. PATIENTS AND METHODS: The diagnosis was established by clinical and radiologic criteria in the course of varicella infection. The antecedents of smoking habit, pregnancy, and underlying disease were evaluated. Hypoxemia was defined as a pO2 < or = 65 mmHg with a FiO2 of 0.21. RESULTS: Twenty-five patients (16 males and 9 women; mean age 31.5 years, range: 24-43 years) were included in the study. Ninety-two percent of patients were smokers of more than 20 cigarettes a day; five met criteria of simple chronic bronchitis, 3 were known carriers of human immunodeficiency virus (HIV) and one had a chronic liver disease caused by hepatitis C virus. In 16 patients (64%) there were no underlying diseases and none of the female patients was pregnant. Respiratory symptoms began from the first and seventh day after the skin rash, and the most common symptoms were cough (76%), dyspnea (48%), and chest pain (44%). In 22 patients an arterial gas determination was obtained and hypoxemia was documented in 8 patients (32%). Hypoxemia was greater and statistically significant in patients with underlying diseases (p < 0.01). Chest X-ray revealed an interstitial pattern predominantly at both bases. Intravenous acyclovir therapy was started in 19 patients (76%) with severe respiratory symptoms and/or underlying disease. Three patients (12%) were admitted to the Intensive Care Unit for mechanical ventilation. All patients had a favourable clinical course. CONCLUSIONS: Adult patients with symptoms of VP had a favourable clinical course with intravenous acyclovir, and the presence of hypoxemia was more commonly observed when underlying diseases were also present.
