Long-term evaluation of home-based pulmonary rehabilitation in patients with COPD.

INTRODUCTION: Personalized, global pulmonary rehabilitation (PR) management of patients with COPD is effective, regardless of the place in which this rehabilitation is provided. The objective of this retrospective observational study was to study the long-term outcome of exercise capacity and quality of life during management of patients with COPD treated by home-based PR. METHODS: Home-based PR was administered to 211 patients with COPD (mean age, 62.3±11.1 years; mean forced expiratory volume in 1 second, 41.5%±17.7%). Home-based PR was chosen because of the distance of the patient's home from the PR center and the patient's preference. Each patient was individually managed by a team member once a week for 8 weeks with unsupervised continuation of physical exercises on the other days of the week according to an individual action plan. Exercise conditioning, therapeutic patient education, and self-management were included in the PR program. The home assessment comprised evaluation of the patient's exercise capacity by a 6-minute stepper test, Timed Up and Go test, ten times sit-to-stand test, Hospital Anxiety and Depression score, and quality of life (Visual Simplified Respiratory Questionnaire, VQ11, Maugeri Respiratory Failure 28). RESULTS: No incidents or accidents were observed during the course of home-based PR. The 6-minute stepper test was significantly improved after completion of the program, at 6 months and 12 months, whereas the Timed Up and Go and ten times sit-to-stand test were improved after PR and at 6 months but not at 12 months. Hospital Anxiety and Depression and quality of life scores improved after PR, and this improvement persisted at 6 months and 12 months. CONCLUSION: Home-based PR for unselected patients with COPD is effective in the short term, and this effectiveness is maintained in the medium term (6 months) and long term (12 months). Home-based PR is an alternative to outpatient management provided all activities, such as exercise conditioning, therapeutic education, and self-management are performed.

Hospitalización a domicilio. Una alternativa asistencial / Hospital at home. A care alternative

La hospitalización a domicilio (HADO) supone una alternativa asistencial capaz de dispensar asistencia médica de rango hospitalario a los pacientes en sus domicilios, cuando ya no precisan de la infraestructura hospitalaria. Proporciona una atención integral al enfermo de determinadas patologías crónicas y agudas y permiten a los niños enfermos permanecer en el domicilio, rodeados de sus familiares y en su entorno. En otros países la hospitalización a domicilio está ampliamente desarrollada en adultos y en el ámbito pediátrico. En España, aunque es una realidad creciente, resulta aún insuficiente y precisa un mayor desarrollo para proporcionar una atención adecuada de los niños enfermos en sus domicilios (AU)

Hospital at Home (HaH) is a care alternative capable of providing hospital range medical care to patients in their homes when they do not require the hospital infrastructure. It provides comprehensive care to the patient with certain chronic and acute conditions and permits ill children to remain at home, surrounded by their family and environment. In other countries, hospital at home is widely developed in adults and in the pediatric setting. In Spain, although in is growing at present, greater development to provide adequate care of ill children in their homes is still insufficient and precise (AU)

Competencias transversales de los profesionales que facilitan atención domiciliaria a pacientes crónicos / Transferable skills of healthcare professionals in providing homecare in chronically ill patients

OBJETIVO: Determinar, a partir de los análisis de los profesionales de atención domiciliaria, el grado de relevancia de las competencias no técnicas de esos profesionales dedicados a la atención de pacientes con enfermedades crónicas. DISEÑO: Investigación cuanti-cualitativa realizada en 2 fases: la 1. a entre noviembre de 2010 y marzo de 2011 y la 2. a entre diciembre de 2012 y agosto de 2013. Emplazamiento: Región Sanitaria de Barcelona ciudad. PARTICIPANTES: En la primera fase, 30 profesionales pertenecientes a 6 equipos de atención domiciliaria (3 del ámbito de la atención primaria y 3 del ámbito hospitalario). En la 2. a fase, 218 profesionales pertenecientes a 50 equipos de atención primaria (EAP) y a 7 programas deatención domiciliaria y equipos de apoyo sanitario y social (PADES). MÉTODO: Muestreo intencional en la 1. a fase y aleatorio en la 2. a. Se emplearon escalas tipo Likert y grupos focales. RESULTADOS: A partir de la identificación de 19 categorías competenciales en la 1. a fase del estudio, se establecieron, en la 2. a fase, 3 metacategorías competenciales: atención integral centrada en el paciente, organización interprofesional y entre niveles asistenciales y competencia relacional. CONCLUSIONES: Es necesario favorecer y garantizar las relaciones profesionales entre niveles asistenciales, la continuidad asistencial, la concepción biopsicosocial y la atención holística al paciente y a su entorno, contemplando emociones, expectativas, sentimientos, creencias y valores de pacientes y familiares. Es imprescindible el diseño e implementación de formación en competencias transversales en el ámbito de cada centro, a través de metodologías didácticas activas y participativas

AIM: To determine the relevance level of non-technical skills of those professionals dedicated to the healthcare of patients with chronic diseases, from an analysis of home care professionals. DESIGN: Quantitative and qualitative research conducted in 2 phases: 1. st from November 2010 to March 2011 and 2. nd from December 2012 to August 2013. SETTING: Health Region of Barcelona city. PARTICIPANTS: During the 1. st phase, 30 professionals from homecare teams (3 from Primary Care and 3 from Hospitals). In 2. nd phase, 218 professionals from 50 Primary Healthcare Centres and 7 home care programmes. Method: Purposive sampling in was used in the1st phase, and randomized sampling in the 2. nd phase. Likert scales and focus group were used. RESULTS: A total of 19 skill categories were identified in the 1. st phase. In the 2. nd phase 3 metacategories were established: comprehensive patient-centered care, interprofessional organization, and inter-health care fields and interpersonal skills. CONCLUSIONS: It is necessary to improve and secure the professionals relationships between levels of healthcare, continuity of healthcare, biopsychosocial model and holistic attention to patients and relatives, looking at emotions, expectations, feelings, beliefs and values. It is essential to design and implement continuing training in transferable skills in every healthcare centre, through active methodologies

The development of Partners for Health's integrated community pathway for postmyocardial infarction patients.

Partners for Health convened an interdisciplinary team to evaluate the quality of care received by cardiac patients. The team detailed the suboptimal postacute care of patients with ischemic heart disease. To solve the quality problems, a cross-sectoral team, using an approach that is in accordance with the American Heart Association's Scientific Statement on Pathways, systematically developed and implemented an integrated community pathway for myocardial infarction patients. The paper contributes to the literature on pathways by presenting the lessons learned from the authors' first-hand experience. The paper concludes with recommendations based on those lessons.

[Evaluation of patients who received treatment (procedures) that involved minor surgical techniques at home].

We retrospectively examined the clinical records of 24 patients who underwent minor surgery under local anesthesia among 207 who were taken care of at home by our staff, from December 1986 to March 2001. There were 17 men and 7 women. Their mean age was 74 years and the range was 50 to 92 years old. The treatment consisted of central vein catheterization in 14 patients, skin suture in 6, subcutaneous implantation of port establishment and epidural catheterization in 3 patients each, treatment of anus, thorax centesis, skin tumor resection, and treatment of bed sores 2 patients each, wash of thorax, ovarian cyst centesis, and transcutaneous trachocentesis 1 patient each. A relationship of trust with the patient and the family and informed consent were thought as the most important aspects regarding treatment involving minor surgery provided at home.

Out-patient and home-parenteral antibiotic therapy (OHPAT): evaluation of the impact of one year's experience in Tayside.

OBJECTIVE: An out-patient and home parenteral antibiotic therapy programme for the treatment of suitable infections was developed over a four year period. This paper describes the impact of one year's experience of its implementation on various measures of outcome. DESIGN: Each patient treatment has a full integrated care pathway (ICP) and patient satisfaction questionnaire completed. The ICP documents the clinical progress of the patient and incorporates various measures of quality of care on the 101 number of patients treated from April 1998 to March 1999 are presented here. SETTING: Dundee Teaching Hospitals NHS Trust (now Tayside University Hospitals NHS Trust). SUBJECTS: Patients with a range of infections requiring intravenous antibiotics. MAIN MEASURES: Number of patients treated with various infections, clinical and microbiological outcome, drug and vascular access complication rates, impact on drug costs and in-patient bed days, and measurement of patient satisfaction/quality of life. RESULTS: Patients were treated over a 12 month period. 51.5 per cent had skin & soft tissue infections and 22.8 per cent bone & joint sepsis. 57 per cent of patients received out-patient and 34 per cent self or carer administered home therapy. Ninety-four per cent of patients were cured or improved following treatment. Only 7.5 per cent of patients required an unscheduled admission to hospital. Twelve per cent of patients had some type of vascular device related adverse event (partly due to a faulty batch of lines) and six per cent of patients had a drug related reaction. The additional daily cost of drugs was minimal (< 12 Pounds/day) and more than 1,461 bed days have been saved across the Directorates. The patient satisfaction level was high.