Derivación a hospitalización a domicilio de pacientes con infección por COVID-19 / Referral to home care of patients with COVID-19 infection

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Executive summary of outpatient parenteral antimicrobial therapy: Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases and the Spanish Domiciliary Hospitalisation Society / Resumen ejecutivo del tratamiento antimicrobiano domiciliario endovenoso: guía de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica y la Sociedad Española de Hospitalización a Domicilio

Outpatient parenteral antimicrobial therapy (OPAT) programmes make it possible to start or complete intravenous antimicrobial therapy for practically any type of infection at home, provided that patient selection is appropriate for the type of OPAT programme available. Although the clinical management of infections in the home setting is comparable in many respects to that offered in conventional hospitalization (selection of antibiotics, duration of treatment, etc.), there are many aspects that are specific to this care modality. It is essential to be aware of them so that OPAT continues to be as safe and effective as inpatient care. The objective of this clinical guideline is therefore to provide evidence- and expert-based recommendations with a view to standardizing clinical practice in this care modality and contribute to a progressive increase in the number of patients who can be cared for and receive intravenous therapy in their own homes

Los programas de tratamiento antibiótico domiciliario endovenoso (TADE) permiten iniciar o completar el tratamiento antimicrobiano por vía endovenosa de prácticamente cualquier tipo de infección en el domicilio, siempre y cuando se realice una selección del paciente acorde al tipo de programa de TADE que se dispone. Aunque hay aspectos del manejo clínico de las infecciones en el domicilio que son superponibles en la mayoría de los casos a la realizada en la hospitalización convencional (selección de la antibioterapia, duración del tratamiento, etc.), existen numerosos aspectos que son específicos de esta modalidad asistencial. Resulta imprescindible conocerlos para que el TADE siga siendo igual de eficaz y seguro que la hospitalización convencional. El objetivo de esta guía clínica es por tanto, proporcionar recomendaciones basadas en la evidencia realizadas por expertos para homogeneizar la práctica clínica de esta modalidad asistencial y contribuir a que se incremente progresivamente el número de pacientes que pueden ser atendidos y recibir tratamiento endovenoso en su propio domicilio

Executive summary of outpatient parenteral antimicrobial therapy: Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases and the Spanish Domiciliary Hospitalisation Society.

Outpatient parenteral antimicrobial therapy (OPAT) programmes make it possible to start or complete intravenous antimicrobial therapy for practically any type of infection at home, provided that patient selection is appropriate for the type of OPAT programme available. Although the clinical management of infections in the home setting is comparable in many respects to that offered in conventional hospitalization (selection of antibiotics, duration of treatment, etc.), there are many aspects that are specific to this care modality. It is essential to be aware of them so that OPAT continues to be as safe and effective as inpatient care. The objective of this clinical guideline is therefore to provide evidence- and expert-based recommendations with a view to standardizing clinical practice in this care modality and contribute to a progressive increase in the number of patients who can be cared for and receive intravenous therapy in their own homes.

[Chronic obstructive pulmonary disease in the setting of hospital at home. Study of 522 episodes]. / Enfermedad pulmonar obstructiva crónica en hospitalización a domicilio. Estudio de 522 casos.

OBJECTIVES: To assess the effectiveness, respiratory status, services of origin and outcome of patient with exacerbated COPD attended in Hospital at Home (HaH) regimen. PATIENT AND METHOD: Study of patients with an exacerbated COPD in HaH from Vitoria-Gasteiz, Spain during the period March 1999-October 2004, in whom hospital admission had been recommended after medical assessment. We studied: age, gender, patient's stay, oxygen-saturation or arterial blood gas analysis, FEV1 (basal), dyspnea status (basal and current), coexisting diseases, exacerbation causes, Services of origin, use of home nebulizers and oxygen therapy, intravenous drugs, course (discharges/admissions/deaths). We analyzed the number of visits to the Emergency Department and hospital admissions 90 days before and after discharge from Hospital at home. RESULTS: A total of 302 patients who generated 522 cases with exacerbated COPD were accepted, 81% of whom are men. Means stay was 11 days (0-111). Three hundred ninety six (76%) of the cases were discharge from HaH, 111 (21%) had to be hospitalized for different reasons, on 13 (2.5%) died. Of these, 43% came from the Respiratory Department and 39% from the Emergency one. Mean FEV1 was 45.4. A total of 89% of the patients had dyspnea 4/4 and 34% 3/4 when seen and 9% of the patients had pneumonia. During the 90 days following discharge from Hospital at Home, the number of visits to the Emergency Department and the rate of hospital admissions decreased significantly (p < 0.001). CONCLUSIONS: Our data confirm that Hospital at Home is a good alternative to conventional hospital admission for the management of patients with exaxerbated COPD.

Enfermedad pulmonar obstructiva crónica en hospitalización a domicilio. Estudio de 522 casos / Chronic obstructive pulmonary disease in the setting of hospital at home. Study of 522 episodes

Objetivos. Analizar la efectividad, situación respiratoria, servicios de procedencia, causas de reingreso y evolución de pacientes con enfermedad pulmonar obstructiva crónica (EPOC) agudizada en una Unidad de Hospitalización a Domicilio (HaD). Pacientes y método. Estudio de pacientes con EPOC agudizada atendidos en la Unidad de HaD de Vitoria-Gasteiz entre marzo de 1999 y octubre de 2004, donde el ingreso hospitalario es recomendado tras valoración médica. Variables estudiadas: edad, sexo, estancia media, saturación de oxígeno o gasometría arterial, volumen espiratorio forzado en el primer segundo (FEV1) basal, grado de disnea (basal y actual), enfermedades coexistentes, causas de la agudización, servicios de procedencia, utilización de nebulizadores, oxigenoterapia y medicación intravenosa y evolución (altas/ingresos/fallecimientos). Analizamos el número de visitas a Urgencias y los ingresos hospitalarios 3 meses antes y 3 meses después de la intervención de HaD. Resultados. Trescientos dos pacientes que generaron 522 casos con EPOC agudizada fueron aceptados. El 81% eran hombres. La mediana de la estancia fue de 11 días (rango: 1-111). En 396 (76%) casos se dio el alta desde HaD. Ciento once (21%) tuvieron que ser hospitalizados por diferentes causas y 13 (2,5%) fallecieron. El 43 % procedían del Servicio Respiratorio y el 39% de Urgencias. El FEV1 medio fue de 45,4. El 89% de los pacientes tenían disnea 3-4/4 en el momento de ser atendidos. El 9% de los pacientes tuvieron neumonía. Durante los 90 días posteriores al alta por HaD el número de visitas a Urgencias y de ingresos disminuyó significativamente (p < 0,001). Conclusiones. Nuestros datos confirman que la HaD es una buena alternativa a la hospitalización convencional para el manejo de pacientes con EPOC agudizada (AU)

Objectives. To assess the effectiveness, respiratory status, services of origin and outcome of patient with exacerbated COPD attended in Hospital at Home (HaH) regimen. Patient and method. Study of patients with an exacerbated COPD in HaH from Vitoria-Gasteiz, Spain during the period March 1999-October 2004, in whom hospital admission had been recommended after medical assessment. We studied: age, gender, patient's stay, oxygen-saturation or arterial blood gas analysis, FEV1 (basal), dyspnea status (basal and current), coexisting diseases, exacerbation causes, Services of origin, use of home nebulizers and oxygen therapy, intravenous drugs, course (discharges/admissions/deaths). We analyzed the number of visits to the Emergency Department and hospital admissions 90 days before and after discharge from Hospital at home. Results. A total of 302 patients who generated 522 cases with exacerbated COPD were accepted, 81% of whom are men. Means stay was 11 days (0-111). Three hundred ninety six (76%) of the cases were discharge from HaH, 111 (21%) had to be hospitalized for different reasons, on 13 (2.5%) died. Of these, 43% came from the Respiratory Department and 39% from the Emergency one. Mean FEV1 was 45.4. A total of 89% of the patients had dyspnea 4/4 and 34% 3/4 when seen and 9% of the patients had pneumonia. During the 90 days following discharge from Hospital at Home, the number of visits to the Emergency Department and the rate of hospital admissions decreased significantly (p < 0.001). Conclusions. Our data confirm that Hospital at Home is a good alternative to conventional hospital admission for the management of patients with exaxerbated COPD (AU)