Peterborough Hospital at Home: an evaluation.

An evaluation of the Peterborough Hospital at Home scheme was undertaken to examine the complementary roles of Hospital at Home, hospital ward and the District Nursing Service. The evaluation involved two surveys; the first was a retrospective study of records of patients admitted to one of the three care settings during 1983. The second survey was a prospective study of Hospital at Home patients in 1985 with the index diagnoses of malignant neoplasms, cerebrovascular accidents and post-operative patients discharged early from hospital. In 1985, 284 patients were admitted to Hospital at Home, and of these the largest group (73 patients) were terminally ill cancer patients. Hospital at Home provided care for more severely ill patients than those normally looked after by the District Nursing Service, and comparable in severity and outcome to those in hospital. There was an emphasis on terminal care by Hospital at Home which would make it appear to be an enhancement to the usual domiciliary nursing services available, as, for the majority of the cancer patients cared for by Hospital at Home, admission to hospital would probably not be sought.

Economic aspects of alternative strategies for the care of elderly people.

Economic analysis of alternative forms of care for elderly people has been slow to develop in many countries because the methodological problems involved are formidable. However, despite these difficulties, a review of studies undertaken in eleven countries has shown that progress has been made in terms of both methodological improvements (measuring costs, effectiveness and preferences for various services) and policy recommendations. It is surprising that similar conclusions occur in different studies. Domiciliary care is economically efficient and preferred by most old people but if this policy is to be successful more resources have to be allocated to relevant services, better housing accommodation, higher income levels and improved social integration.

Extended training of ambulance staff in England.

It has been widely demonstrated that it is possible to teach ambulance staffs to carry out the extended trained skills of endotracheal intubation, intravenous infusion and ventricular defilbrillation. So far in England only a few health authorities have been able to develop courses i advanced ambulance aid. Data on the costs of this training in six authorities presently operating such courses were collected, together with the costs of operating vehicles crewed by extended trained staff. Training and operating costs vary according to the different organisation of the training schemes and the way in which the extended trained staff are deployed on operational duties. Total costs vary between 235 pounds and 878 pounds per trained person per year. The experience of different health authorities in the U.K. and in the U.S.A. operating ambulance services with extended trained staff is then examined to try to identify the benefits of reduced mortality and morbidity which accrued from the introduction of the improved service. Most of this experience is concerned with reduced mortality from the treatment of out-of-hospital cardio-pulmonary arrest, and the estimates of the life-saving potential of the service varied from one area to another. The most conservative estimate was that one fully equipped, permanently available vehicle staffed by extended trained personnel would save 3-4 lives per year. Although there is very little evidence available of reduced mortality and morbidity from trauma and other sudden serious illness, some experience indicated a further 1 or 2 lives could be saved per vehicle per year.(ABSTRACT TRUNCATED AT 250 WORDS)