[Specialized home care of medical diseases in an urban tertiary university hospital. Coordination between the medical services of the hospital and the primary health care]. / Atención especializada domiciliaria de patologías médicas desde un hospital universitario terciario urbano. Coordinación entre los servicios médicos del hospital y la Atención Primaria de salud del territorio.

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.

[Fast specialized ambulatory care of medical disease in an urban tertiary university hospital. Fast care consultation]. / Atención especializada ambulatoria rápidade patologías médicas desde un hospital universitario terciario. Consulta de atención inmediata.

INTRODUCTION: The experience of an urban tertiary university hospital in the design and establishment of Specialized Ambulatory Consultation (SAC) of Internal Medicine is presented. The purpose of this consultation is fast specialized ambulatory care of medical diseases, decrease of inappropriate hospitalizations and improvement of coordination with primary health care. PATIENTS AND METHOD: Systematic collection of the following variables in all the patients who visited the SAC between March 2006 and February 2007: origin, syndromic diagnosis and reason for consultation, age and gender, number of visits, examinations made, and destination on discharge. The descriptive statistical analysis was made in March 2007. RESULTS: A total of 744 patients with 1248 visits were seen (successive/first ratio of 0.67). Mean age was 62.56 (18.6) years and 50.6% were women. The hospital origin/primary origin went from 3.5 - 4 in the first quarter to between 2.6 - 2.8 in the last quarter. The main reasons for consultation due to patient with constitutional or anemic syndromes with suspicion of serious disease and patients with decompensation of chronic diseases or infectious disease. Half of the patients returned to primary care and the rest were distributed among different hospital resources. It stands out that 30% were sent to the hospital consultations and 10% required hospitalization or transfer to the emergency room. CONCLUSIONS: The SAC is a Fast Consultation Care (diagnosis and treatment) of general internal medicine located in a tertiary university hospital with a good capacity of resolution. It facilitates Specialized Ambulatory Care of medical diseases, decreasing inappropriate hospitalization and improving coordination with the Primary Health Care.