La hospitalización domiciliaria del paciente agudo: un nuevo enfoque de cuidados / Home hospitalization of the acute patient: a new approach to care

La hospitalización a domicilio (HAD) pediátrica tiene como objetivo proveer al paciente y a su familia de una alternativa a la hospitalización convencional, de forma segura y eficaz, mejorando la calidad de vida del paciente y su familia. Las patologías más frecuentes en HAD de paciente agudo pediátrico son la patología respiratoria aguda y las infecciones bacterianas que precisan antibioterapia parenteral. El éxito de un programa de hospitalización domiciliaria de paciente agudo recae en la adecuada selección de pacientes y la exhaustiva capacitación de los cuidadores, así como en una buena comunicación y coordinación entre los diferentes servicios y niveles de atención implicados.(AU)

Pediatric hospitalization at home (HAH) aims to provide the patient and his family with an alternative to conventional hospitalization, safely and effectively, improving the quality of life of the patient and his family. The most frequent pathologies in HAH in pediatric acute patients are acute respiratory pathology and bacterial infections that require parenteral antibiotic therapy. The success of an acute patient home hospitalization program relies on the proper selection of patients and exhaustive training of caregivers, as well as good communication and coordination between the different services and levels of care involved.(AU)

Proposal for a general framework for the administration of anticancer immunotherapy in a hospital-at-home care.

INTRODUCTION: Immunotherapy has transformed the treatment paradigm of several cancers. Hospital-at-home (HAH) care is an innovative healthcare model in which treatments are delivered at home under the supervision of a hospital, which likely applies to cancer immunotherapy. For this home-care option, official treatment guidelines are still lacking. We therefore sought to create guidance and recommendations on how to administer immune response checkpoint inhibitor therapies and other monoclonal antibodies used in cancer treatment in the context of HAH setting. METHODS: A multidisciplinary group of healthcare professionals with expertise in managing cancer patients and prescribing immunotherapy in HAH settings was set up. RESULTS: Based on the survey results and working group discussions, six major components were identified: (1) existing HAH organization in France; (2) underlying framework; (3) flowchart; (4) patient pathway before, the day of, and after immunotherapy; (5) healthcare personnel training; (6) patient therapeutic education. The detailed specifications for each component are provided herein, along with an illustrative flowchart. The prerequisites for home administration of cancer immunotherapies are summarized in Table 1. DISCUSSION: This paper seeks to facilitate the implementation of cancer immunotherapy within HAH settings for the healthcare professionals concerned.

Immune checkpoint inhibitors and hospitalization at home in France.

CONTEXT: The administration of immune checkpoints inhibitors (ICIs) within hospitalization at home (HaH) organizations is an interesting alternative to conventional care. Three surveys were carried out to describe the different organizational models of French HaHs and criteria used by physicians in patient selection. METHODS: Three surveys were conducted between April 1 and August 31, 2020. The first one was addressed to all French HaHs, and the two others to public HaHs and oncologists treating patients with solid cancer in the Auvergne-Rhone-Alpes region. RESULTS: Overall, 54 French HaHs and 23 oncologists participated to the study. The health professionals involved in the patients' care were very heterogeneous, although in 92% of cases, the treatment prescription was made by the oncologist. HaH physicians were more involved in clinical assessment the day before treatment (19% vs. 0%), treatment validation (56% vs. 15%), and treatment prescription (19% vs. 0%), while nurses were better equipped (emergency kit available in 81% versus 50% of cases) when HaHs did carry out ICIs compared to when they did not. Most oncologists agreed that age, neuropsychiatric disorders, home environment, as well as treatment duration and good tolerance should be considered in patient selection. ECOG PS status and treatment response were less consensually considered. CONCLUSION: These results highlight the variability in French HaH organizations and patient selection criteria for employing ICIs at home. This study resulted in recommendations for administrating ICIs in HaH settings, which will likely be instrumental in further promoting this activity across France.

The Virtual Hospital: An Innovative Solution for Disaster Response.

Like any disaster, the COVID-19 pandemic has presented significant challenges to healthcare systems, especially the threat of insufficient bed capacity and resources. Hospitals have been required to plan for and implement innovative approaches to expand hospital inpatient and intensive care capacity. This article presents how one of the largest healthcare systems in the United States leveraged existing technology infrastructure to create a virtual hospital that extended care beyond the walls of the "brick and mortar" hospital.

Home-based versus outpatient pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease: A protocol for systematic review and meta-analysis.

BACKGROUND: Although home-based pulmonary rehabilitation programs have been shown in some studies to be an alternative and effective model, there is a lack of consensus in the medical literature due to different study designs and lack of standardization among procedures. Therefore, the purpose of this study was to compare the efficacy of a home-based versus outpatient pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease (COPD). METHODS: Five electronic databases including Embase, PubMed, Scopus, Science Direct, and Cochrane Library will be searched in May 2021 by 2 independent reviewers. The reference lists of the included studies will be also checked for additional studies that are not identified with the database search. There is no restriction on the dates of publication or language in the search. The randomized controlled trials focusing on comparing home-based and outpatient pulmonary rehabilitation for COPD patients will be included in our meta-analysis. The following outcomes should have been measured: functional exercise capacity, disease-specific health-related quality of life, and cost-effectiveness measures. Risk ratio with a 95% confidence interval or standardized mean difference with 95% CI is assessed for dichotomous outcomes or continuous outcomes, respectively. RESULTS: It was hypothesized that these 2 methods would provide similar therapeutic benefits. REGISTRATION NUMBER: 10.17605/OSF.IO/5CV48.

Quality of end-of-life care of home-based care with or without palliative services for patients with advanced illnesses.

ABSTRACT: Palliative care has improved quality of end-of-life (EOL) care for patients with cancer, and these benefits may be extended to patients with other serious illnesses. EOL care quality for patients with home-based care is a critical problem for health care providers. We compare EOL quality care between patients with advanced illnesses receiving home-based care with and without palliative services.The medical records of deceased patients who received home-based care at a community teaching hospital in south Taiwan from January to December 2019 were collected retrospectively. We analyzed EOL care quality indicators during the last month of life.A total of 164 patients were included for analysis. Fifty-two (31.7%) received palliative services (HP group), and 112 (68.3%) did not receive palliative services (non-HP group). Regarding the quality indicators of EOL care, we discovered that a lower percentage of the HP group died in a hospital than did that of the non-HP group (34.6% vs 62.5%, P = .001) through univariate analysis. We found that the HP group had lower scores on the aggressiveness of EOL care than did the non-HP group (0.5 ±â€Š0.9 vs 1.0 ±â€Š1.0, P<.001). Furthermore, palliative services were a significant and negative factor of dying in a hospital after adjustment (OR = 0.13, 95%CI = 0.05-0.36, P < .001).For patients with advanced illnesses receiving home-based care, palliative services are associated with lower scores on the aggressiveness of EOL care and a reduced probability of dying in a hospital.

Intensive Treatments in Adolescent Anorexia Nervosa.

Approximately one-fifth to one-third of patients with adolescent anorexia nervosa (AN) need intensive care in the course of their illness. This article provides an update and discussion on different levels of intensive care (inpatient treatment (IP), day patient treatment (DP) and home treatment (HoT)) in different health care systems based on recently published literature. Important issues discussed in this article are new recommendations for the refeeding process and the definition of target weight as well as principles of medical stabilization and psychotherapeutic approaches. The pros and cons of longer or shorter hospitalization times are discussed, and the advantages of stepped care and day patient treatment are described. A new promising intensive treatment method involving the patient, their caregivers and the direct home environment is introduced. Parents and caregivers should be included in treatment research to foster collaborative work with the attending clinicians. There is an urgent need to evaluate the mid- to long-term outcomes of various intensive treatment programs to compare their effectiveness and costs across different health care systems. This could help policy makers and other stakeholders, such as public and private insurances, to enhance the quality of eating disorder care.

COVID-19 outbreak: An experience to reappraise the role of hospital at home in the anti-cancer drug injection.

BACKGROUND: The COVID-19 outbreak has posed considerable challenges to the health care system worldwide, especially for cancer treatment. We described the activity and the care organisation of the Hospitalisation At Home (HAH) structure during the pandemic for treating patients with anti-cancer injections. METHODS: We report the established organisation, the eligibility criteria, the patient characteristics, the treatment schemes and the stakeholders' role during two 5-week periods in 2020, before and during the French population's lockdown. RESULTS: The increase of activity during the lockdown (+32% of treated patients, +156% of new patients and +28% of delivered preparations) concerned solid tumour, mainly breast cancer, even if haematological malignancies remained the most frequent. Thirty different drugs were delivered, including three new drugs administered in HAH versus 19 during the routine period (p < 0.01). For those clinical departments accustomed to using HAH, the usual organisation was kept, but with adjustments. Five clinical departments increased the number of patients treated at home and widened the panel of drugs prescribed. Three oncology departments and one radiotherapy department for the first time solicited HAH for anti-cancer injections, mainly for immunotherapy. We adjusted the HAH organisation with additional human resources and allowed to prescribe drugs with an infusion time of <30 min only for the new prescribers. CONCLUSION: HAH allowed for the continuation of anti-cancer injections without postponement during the pandemic, and for a decrease in unnecessary patient travel to hospital with its concomitant COVID-19 transmission risk. Often left out of guidelines, the place of HAH in treating cancer patients should be reappraised, even more so during a pandemic.

[Home telemonitoring and oxygen therapy in COVID-19 patients: safety, patient satisfaction, and cost-effectiveness]. / Thuisbehandeling van covid-19-patiënten met zuurstof en telemonitoring.

OBJECTIVE: To evaluate the implementation of home telemonitoring and oxygen therapy in COVID-19 patients. Primary outcomes were safety, patient satisfaction, reduction of hospital stay, and cost-effectiveness. DESIGN: Retrospective cohort study. METHOD: All COVID-19 patients who were discharged with home telemonitoring and oxygen therapy between June 1st and November 1st 2020 were included. Eligible patients had a maximum oxygen requirement of 2 liters per minute during the 24 hours prior to discharge with a minimal peripheral oxygen saturation of 94%. A mobile application for telemonitoring was used, which patients or relatives had to be able to use independently. Patient demographics, clinical parameters, data on telemonitoring and readmissions were extracted from the electronic patient records. A survey for patient satisfaction and a cost-effectiveness analysis were performed. RESULTS: Out of 619 admissions, 49 patients were discharged with home telemonitoring and oxygen therapy. Median duration of home oxygen therapy was 11 days with a potential reduction in hospitalization of 616 days. Six patients were readmitted and were significantly more febrile on discharge (67% versus 14%, p=0.01) and had lower oxygenation (95%, (IQR 93-96) versus 96%, (IQR 95-97), p=0.02) with similar levels of oxygen administration. Patient satisfaction was high with a mean score of 5 to 6 on a scale measuring satisfaction from 1 to 7. Estimated total cost reduction was € 146.736. CONCLUSION: This study shows that home telemonitoring and oxygen administration can be safely applied in COVID-19 patients resulting in a high patient satisfaction and reduction in hospital stay and costs.

"At Home, with Care": Lessons from New York City Home-based Primary Care Practices Managing COVID-19.

BACKGROUND/OBJECTIVES: COVID-19 required rapid innovation throughout the healthcare system. Home-based primary care (HBPC) practices faced unique challenges maintaining services for medically complex older populations for whom they needed to adapt a traditionally hands-on, model of care to accommodate restrictions on in-person contact. Our aim was to determine strategies used by New York City (NYC)-area HBPC practices to provide patient care during the first wave of the COVID-19 pandemic with the goal of informing planning and preparation for home-based practices nationwide. DESIGN: Cross-sectional qualitative design using semi-structured interviews. SETTING: HBPC practices in the NYC metro area during spring 2020. PARTICIPANTS: HBPC leadership including clinical/medical directors, program managers, nurse practitioners/nursing coordinators, and social workers/social work coordinators (n = 13) at 6 NYC-area practices. MEASUREMENTS: Semi-structured interviews explored HBPC practices' COVID-19 care delivery challenges, adaptations, and advice for providers. Interviewers probed patient care, end-of-life care, telehealth, community-based services and staffing. Interviews were recorded and transcribed. Data were analyzed through a combined inductive and deductive thematic approach. RESULTS: Participants described care delivery and operational adaptations similar to those universally adopted across healthcare settings during COVID-19, such as patient outreach and telehealth. HBPC-specific adaptations included mental health services for patients experiencing depression and isolation, using multiple modalities of patient interactions to balance virtual care with necessary in-person contact, strategies to maintain patient trust, and supporting team connection of staff through daily huddles and emotional support during the surge of deaths among long-standing patients. CONCLUSION: NYC-area HBPC providers adapted care delivery and operations rapidly during the height of the COVID-19 pandemic. Keeping older, medically complex patients safe in their homes required considerable flexibility, transparency, teamwork, and partnerships with outside providers. As the pandemic continues to surge around the United States, HBPC providers may apply these lessons and consider resources needed to prepare for future challenges.

La "nueva normalidad": ¿qué opinan nuestros pacientes? / The "new normality": what do our patients think?

OBJETIVO: Valorar la satisfacción percibida con el programa de Telefarmacia y envío a domicilio implantado, así como las preferencias de los pacientes y /o cuidadores por el modelo asistencial de atención farmacéutica y dispensación cuando se alcance la "nueva normalidad". MÉTODO: Se diseñó una encuesta electrónica anónima mediante la aplicación Microsoft Forms. La población diana fueron los pacientes, o cuidadores, atendidos en la Unidad de Atención Farmacéutica a Pacientes Externos mediante el modelo de Telefarmacia y envío de medicación a su domicilio entre el 30 de abril al 18 de mayo de 2020. RESULTADOS: Se enviaron 327 cuestionarios, obteniendo una tasa de respuesta del 45,0%. El 95,9% indicó que recibió la medicación correctamente en su domicilio, ajustándose al tiempo estimado de entrega y en perfecto estado. El 99,3% refirió estar satisfecho con el servicio de Telefarmacia y envío a domicilio. El 76,2% prefieren, una vez finalizado el estado de alarma, la Telefarmacia y envío a domicilio de la medicación. La única variable sociodemográfica que se asoció de manera significativa con las preferencias de los pacientes por el modelo de Telefarmacia y envío a domicilio fue la distancia al domicilio del paciente. CONCLUSIONES: Se considera necesario adecuar los modelos asistenciales, debiendo incorporar a la práctica diaria el modelo de atención farmacéutica telemática, junto con el envío domiciliario de medicación, modelo válido, sustentado en la factibilidad de los envíos domiciliarios, el mantenimiento de la atención farmacéutica y la satisfacción y preferencias de los pacientes. Afortunadamente, los primeros pasos están dados y el proceso es irreversible

AIM: To assess the perceived satisfaction with the implemented Telepharmacy and home drug delivery program, as well as the preferences of patients and / or caregivers for the healthcare model of pharmaceutical care and dispensing when the "new normality" is reached. METHOD: An anonymous electronic survey was designed using the Microsoft Forms application. The target population were the patients, or caregivers, treated in the Outpatient Unit using the Telepharmacy model who received the prescribed medication in their homes between April 30 to May 18, 2020. RESULTS: 327 questionnaires were sent, obtaining a response rate of 45.0%. 95.9% indicated that they received the medication correctly at home, adjusting to the estimated delivery time and in perfect condition. 99.3% reported being satisfied with the Telepharmacy and home delivery service. 76.2% prefer, once the alarm state is over, Telepharmacy and home drug delivery of the medication. The only sociodemographic variable that was significantly associated with patient preferences for the Telepharmacy and home drug delivery model was the distance to the patient's home. CONCLUSIONS: The healthcare models should be modified, and the telematic pharmaceutical care model should be incorporated into daily practice together with the home delivery of medication. It is considered a valid model, based on the feasibility of home delivery, the maintenance of pharmaceutical care and patient satisfaction and preferences. Fortunately, the first steps are taken, and the process is irreversible

La atención en casa: el apoyo familiar en el control glicémico en pacientes con diabetes mellitus tipo 2 / Home care: family support in glycemic control in patients with type 2 diabetes mellitus

INTRODUCCIÓN: La diabetes mellitus tipo 2 (DM2) es una enfermedad en la que el sujeto presenta alteraciones metabólicas de los carbohidratos, proteínas y grasas, de origen genético, por una deficiencia de la secreción de insulina o por la incapacidad para utilizarla, con grados variables de resistencia a ésta. Un individuo con diabetes debe de cambiar su estilo de vida, para lo cual es importante que reciba ayuda, generalmente de su familia. OBJETIVO: Describir la trascendencia entre la atención en casa y/o apoyo familiar de la persona que vive con diabetes mellitus tipo 2 en lo que respecta al control glucémico. MÉTODO: Estudio observacional, transversal en pacientes DM Tipo 2. Se aplicó 100 encuestas para la recolección de información que midió el apoyo familiar percibido por el paciente diabético. RESULTADOS: El promedio de edad de los participantes fue de 45 años, el 55 % de la muestra correspondió al sexo masculino. El 57% de la población presenta niveles glucémicos superiores a 200 mg/dl. 27% presentan apoyo familiar y este es menor en las mujeres. CONCLUSIÓN: De acuerdo con los resultados obtenidos se concluye que el apoyo familiar es uno de los factores que influyen directamente con el cumplimiento del tratamiento farmacológico y no farmacológico

INTRODUCTION: Diabetes mellitus type 2 (DM2) is a disease in which the subject presents metabolic alterations of carbohydrates, proteins and fats, of genetic origin, due to a deficiency in insulin secretion or due to the inability to use it, with variable degrees of insulin resistance to it. An individual with diabetes should change their lifestyle, for which it is important that they receive help, usually from their family. OBJECTIVE: Describe the importance of home care and / or family support for the person living with type 2 diabetes mellitus in regard to glycemic control. METHOD: Observational, cross-sectional study in DM Type 2 patients. 100 surveys were applied to collect information that measured the family support perceived by the diabetic patient. RESULTS: The average age of the participants was 45 years, 55% of the sample corresponded to the male sex. 57% of the population have glycemic levels higher than 200 mg / dl. 27% have family support and this is lower in women. CONCLUSION: According to the results obtained, it is concluded that family support is one of the factors that directly influence the compliance of pharmacological and non-pharmacological treatment

Intervenciones desde la farmacia comunitaria en los pacientes adultos que reciben atención de la salud a domicilio: revisión exploratoria / Community pharmacy interventions in adult patients receiving home health care: an exploratory review

OBJETIVOS: Revisar la literatura científica relacionada con las intervenciones desde la farmacia comunitaria en los pacientes adultos que recibieron atención de la salud a domicilio. MÉTODOS: Revisión exploratoria de los artículos recuperados de las bases de datos bibliográficas MEDLINE (PubMed), Embase, Cochrane Library, Scopus y Web of Science hasta marzo de 2020. La ecuación de búsqueda se formuló́ mediante los descriptores "Home Care Services" y "Pharmacies" o "Community Pharmacy Services", utilizando también los Entry Terms relacionados y los filtros: «Humans» y «Adult: 19+ years». La calidad de los artículos se evaluó́ mediante el cuestionario STROBE. RESULTADOS: De las 307 referencias recuperadas, tras aplicar los criterios de inclusión y exclusión, se seleccionaron 44 artículos: 11 estudios descriptivos transversales y 10 ensayos aleatorizados controlados. En 19 (43%) de estos se observó que las intervenciones realizadas desde la farmacia comunitaria aumentaron la adherencia fármaco-terapéutica. También, un mejor conocimiento sobre los medicamentos (administración, seguridad, dosis, posología) en 17 (38,6%) trabajos y en 13 (29,5%) estudios se consiguió la prevención o resolución de los PRM. Al evaluar la calidad de los artículos seleccionados para la revisión mediante el cuestionario STROBE, las puntuaciones oscilaron entre un mínimo de 11 y un máximo de 20,8 sobre una puntuación máxima de 22. CONCLUSIONES: La intervención farmacéutica, a través de la farmacia comunitaria, aportó beneficios en la población más adulta, mediante el aumento de la adherencia farmacoterapéutica, la disminución de los problemas relacionados con los medicamentos y la mejora en el almacenamiento y conservación de los mismos

OBJECTIVE: To review the scientific literature related to interventions from the community pharmacy in adult patients who received home health care. METHOD: Exploratory review of the articles retrieved from the bibliographic databases MEDLINE (PubMed), Embase, Cochrane Library, Scopus and Web of Science until March 2020. The search equation was formulated using the descriptors "Home Care Services" and "Pharmacies" or "Community Pharmacy Services", also using the related Entry Terms and filters: "Humans" and "Adult: 19+ years". The quality of the articles was evaluated using the STROBE questionnaire. RESULTS: From the 307 references retrieved, after applying the inclusion and exclusion criteria, 44 articles were selected: 11 cross-sectional descriptive studies and 10 randomized controlled trials. In 19 (43%) of these, it was observed that the interventions carried out by the community pharmacy increased drug-therapeutic adherence. Also, a better knowledge of medications (administration, safety, dosage, dosage) in 17 (38.6%) studies and in 13 (29.5%) studies, the prevention or resolution of DRM was achieved. Once the articles were evaluated by means of the STROBE questionnaire for this review the scores ranged from a minimum of 11 to a maximum of 20.8 out of a maximum score of 22. CONCLUSIONS: Pharmaceutical intervention, through community pharmacy, brought benefits in the older adult population, by increasing pharmacotherapeutic adherence, reducing drug-related problems, and challenges in preserving and storing medications

Utilidad de los relojes inteligentes en las unidades de hospitalización a domicilio / Usefulness of smartwatches in hospital at home units

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Atención primaria y domiciliaria al final de la vida en tiempos de COVID-19 / Primary and home care at the end of life in the COVID-19's time

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New models of care and multidimensional solutions for oncological patients in the post-acute SARS-COV-2 period: a "Second Phase" also for cancer patients.

In Italy, SARS-CoV-2 outbreak registered a high transmission and disease rates. During the acute phase, oncologists provided to re-organize services and prioritize treatments, in order to limit viral spread and to protect cancer patients. The progressive reduction of the number of infections has prompted Italian government to gradually loosen the national confinement measures and to start the "Second phase" of measures to contain the pandemic. The issue on how to organize cancer care during this post-acute SARS-CoV-2 phase appears crucial and a reassessment of healthcare services is needed requiring new models of care for oncological patients. In order to address major challenges in cancer setting during post-acute SARS-CoV-2 phase, this work offers multidimensional solutions aimed to provide a new way to take care of cancer patients.

Community frailty response service: the ED at your front door.

We describe the expansion and adaptation of a frailty response team to assess older people in their usual place of residence. The team had commenced a weekend service to a limited area in February 2020. As a consequence of demand related to the COVID-19 pandemic, we expanded it and adapted the model of care to provide a 7-day service to our entire catchment area. Five hundred and ninety two patient reviews have been completed in the first 105 days of operation with 43 patients transferred to hospital for further investigation or management following assessment.

Hospitalización domiciliaria en un área rural, ¿una alternativa a la hospitalización tradicional? / Home care services provided by hospital in a rural area, an alternative to traditional hospitalization?

INTRODUCCIÓN: El servicio de hospitalización domiciliaria en el área rural es un servicio poco conocido en el resto del ámbito sanitario. Al mismo tiempo existe poca literatura al respecto por lo que con este estudio queremos estudiar las características clínicas, la estancia media y la tasa de reingresos de los pacientes que ingresan en hospitalización domiciliaria en comparación a los pacientes que ingresan en planta de medicina interna pertenecientes a un hospital comarcal de un área rural (Hospital de TresMares). MÉTODO: Estudio descriptivo comparativo retrospectivo que incluye un total de 200 pacientes (100 ingresados en hospitalización domiciliaria y 100 ingresados en planta) del hospital de TresMares. RESULTADOS: La complejidad de los pacientes que ingresan en planta es superior a los que ingresan en hospitalización domiciliaria requiriendo al mismo tiempo de mayor uso de recursos. La eficacia, entendida como tasa de reingreso, en hospitalización a domicilio es similar a la de los pacientes de la planta. Se demuestra que la hospitalización domiciliaria puede ser una alternativa a la hospitalización tradicional en un área rural. CONCLUSIONES: Se demuestra que la hospitalización domiciliaria puede ser una alternativa a la hospitalización tradicional en un área rural

INTRODUCTION: Hospital home care in a rural area is a hospital care little known in health field. At the same time there is little literature so we want to study the clinical characteristics, the average stay and the readmission rate of patients admitted to home hospitalization compared to patients admitted to the internal medicine hospitalization to a regional hospital in a rural area (Hospital de TresMares). METHOD: retrospective comparative descriptive study includes 200 patients (100 patients admitted to home hospitalization and 100 patients admitted to the hospital). RESULTS: the complexity of the patients admitted to the hospital is greater than those admitted to home hospitalization, while requiring greater use of resources. The efficacy, understood as re admission rate, in hospitalization at home is similar that the patients who are admitted in the hospital. CONCLUSIONS: home hospitalization can be an alternative to tradicional hospitalization in a rural are

La enfermería más allá del contexto hospitalario / Nursing beyond the hospital context

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Atención a domicilio a ancianos crónicos complejos. Una gran responsabilidad para las enfermeras del presente y del futuro / No disponible

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