[Chronic obstructive pulmonary disease in the setting of hospital at home. Study of 522 episodes]
Journal - Revista clínica española (Spain )
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.
|ISSN : ||0014-2565|
|Mesh Heading : ||Aged Emergency Service, Hospital Female Hospitalization Humans Male Pulmonary Disease, Chronic Obstructive Respiratory Function Tests Spain Treatment Outcome statistics & numerical data statistics & numerical data statistics & numerical data|
|Mesh Heading Relevant : ||Home Care Services, Hospital-Based therapy|
[Home intravenous antibiotic treatment: a study in 515 patients]
Journal - Enfermedades infecciosas y microbiología clínica (Spain )
OBJECTIVE: To assess the effectiveness of therapy, type of infection, hospital department of origin and outcome of 515 cases of infection requiring home intravenous antibiotic therapy treated by the home care service. METHODS: The clinical records of patients undergoing intravenous antibiotic therapy through the home care service over a 6-year period were retrospectively reviewed. RESULTS: A total of 439 patients (244M/195F; mean age, 55.9 years, range 7-96) requiring 515 courses of home intravenous antibiotic therapy were reviewed. Mean duration of antibiotic therapy was 7.9 days (1-58). Urinary (42.3%) and respiratory infections (25.8%) were the most frequent indications for home treatment. Most patients were referred from the emergency room (50.5%) followed by the Internal Medicine Department (11.5%) and Oncology Department (11.1%). Ceftriaxone was the most widely prescribed antibiotic (41.8%) followed by aminoglycosides (35.3%) and glycopeptides (11.7%). In 49 cases electronic infusion pumps were used, with ceftazidime being the predominant antibiotic (32.7%) in these cases. Hospitalization was required in 7% of patients due to infectious disease-related complications. Clinical outcome was positive in 79% of the patients, with improvement in 90% of patients from the emergency room CONCLUSIONS: The advantages of home care services to provide home intravenous antibiotic therapy are evident. More than half of the patients were referred from the emergency room and 90% of these progressed well. The presence of medical and nursing staff qualified to handle infectious diseases is necessary, as well as continuing home care.
|ISSN : ||0213-005X|
|Mesh Heading : ||Adolescent Adult Aged Aged, 80 and over Anti-Bacterial Agents Child Female Humans Infusion Pumps Male Middle Aged Respiratory Tract Infections Spain Urinary Tract Infections drug therapy drug therapy|
|Mesh Heading Relevant : ||Home Care Services, Hospital-Based Home Infusion Therapy Infusions, Intravenous administration & dosage|
[Pneumonia in the elderly. Factors related with the mortality during the episode and after the discharge]
Journal - Medicina clínica (Spain )
BACKGROUND AND OBJECTIVE: Pneumonia in the elderly (PIE) is a growing disease that causes great morbidity and mortality with frequent admissions to hospital and increasing health costs. The objective of our study was yo analyze the characteristics of PIE in an internal medicine hospital ward, the influence of quality of life (Katz index and scale of Karnofsky) on its evolution and after the discharge and the factors of poor prognosis during the episode of PIE and throughout the ambulatory follow-up. PATIENTS AND METHOD: All the patients suffering from PIE admitted to the internal medicine ward of our hospital during a two years period were included in the study (125). Five of them were referred from geriatric centers. Mean age was 77.9 years (range = 65-95). The most frequent chronic disease was COPD (53.6%) and 10.4% were taking oral corticosteroids. We studied the association of several factors laboratory, clinical and radiological with the evolution of PIE and after discharge. RESULTS: Patients rated high on the indicators of quality of life used (78.4% scored 5 or greater on the Katz index and 76% scored 80 or greater on the scale of Karnofsky) and their comorbidity was low (44% lesser than or equal to 1 and 6.4% greater than or equal to 5). Fever above 38 C was recorded in 40% of cases. Mean APACHE score was 12.8. 21.6% patients had pleural effusion and 20% had multilobar involvement. Overall mortality was 8.8% (11 patients). Fifteen patients suffered major complications during admission. One hundred patients out of the 114 who survived the episode of PIE were followed up on an ambulatory basis. Thirty of those died within 12 months after discharge. CONCLUSIONS: In our study, a poorer quality of life and a higher APACHE score were related to a greater mortality during the episode of PIE. After hospital discharge, a greater mortality was associated with a poor quality of life, comorbidity and low concentrations of albumin.
|ISSN : ||0025-7753|
|Mesh Heading : ||Age Factors Aged Aged, 80 and over Cause of Death Comorbidity Female Hospitalization Humans Male Multivariate Analysis Patient Discharge Pneumonia Risk Factors Severity of Illness Index Survival Analysis Survival Rate statistics & numerical data statistics & numerical data therapy|
|Mesh Heading Relevant : ||microbiology mortality|
[Treatment of congestive heart failure in the setting of hospital at home. Study of 158 patients]
Journal - Medicina clínica (Spain )
BACKGROUND AND OBJECTIVE: Hospital at Home might become a suitable alternative to traditional hospital admissions for several exacerbated chronic diseases. Congestive heart failure represents an important workload at the hospital level. In this study we present the results of our experience with congestive heart failure patients attended in Hospital at Home regimen during the period 1999-2001. PATIENTS AND METHOD: In 1999 we initiated a program to refer patients with congestive heart failure to Hospital at Home care. The program was agreed by the departments of emergency, cardiology, internal medicine and hospital at home. During the period 1999-2001, 158 patients (mean age = 76) were attended. Ninety one (58%) were women. At the moment of admission, 103 patients (68%) were on functional status IV of the NYHA. RESULTS: On average, patient's stay on hospital at home was 12,8 days. One hundred and twenty three (78%) of them were discharged, 29 (18%) had to be referred back to conventional hospitalisation and six (4%) died. During the 90 days following the discharge from Hospital at Home, the number of visits to the emergency department and the rate of hospital admissions decreased significantly. CONCLUSIONS: Our data confirm Hospital at Home as a valid option to conventional hospital admission for the management of patients with congestive heart failure.
|ISSN : ||0025-7753|
|Mesh Heading : ||Aged Aged, 80 and over Female Heart Failure Home Care Services, Hospital-Based Humans Length of Stay Male Patient Admission Patient Discharge Patient Readmission Treatment Outcome statistics & numerical data statistics & numerical data statistics & numerical data|
|Mesh Heading Relevant : ||therapy statistics & numerical data statistics & numerical data|