Home and Community Care Digest
Acceptance of specialized nurse practitioners delivering care in the home over traditional hospitalization
The results of this limited study suggest that providers and recipients of care may be prepared to accept specialized care in the home when delivered by nurse practitioners as an alternative to traditional hospitalization. All participants in the hospital in the home program, including patients, informal caregivers, and health care providers reported high levels of satisfaction. The impact of the program on the physician's workload was minimal.
Background: The purpose of this study was to evaluate the acceptance by patients, caregivers, and physicians of a hospital in the home program, when delivered by nurse practitioners in Ottawa, Canada. The "hospital in the home" (HITH) program offers the potential to provide more services in the community, increase patient independence, lower costs, and improve quality of life. In addition, this new model of delivery may provide opportunities for nurse practitioners to take on expanded roles in the health care system. The basic requirements of a hospital in the home model include: reduces or eliminates in-patient hospital stays; provides similar care as found in a hospital setting, where clinically appropriate; and not provided by the usual community home care services.
Methods: Patients who had acute but non-critical hospital care, had safe home environments, and were medically and physically stable were recruited from the Family Medicine Service or the Emergency Department at the Ottawa Hospital to participate in this study. Participants, family members, nurse practitioners, and physicians were interviewed and surveyed for their feedback on their experiences with the program.
The hospital in the home program was delivered by specially trained nurse practitioners (NP) who provided rehabilitative and supportive care, including education, coordination of services, and counseling. Overall patient management remained the responsibility of the hospital attending physician. NPs were available during regular business hours and for four hours during the weekend. Immediately following each patient's transfer to the home, a NP made a home visit, performed a physical examination and initiated care provision, continuing daily visits and telephone contact until discharged.
Findings: The majority of patients reported high levels of satisfaction regarding the HITH program, indicating they learned how to better manage their condition. This finding is important as nearly 50% suffered from the same condition during the past year, of which 83% required hospitalization. Nearly 40% of participants reported a preference for receiving care in the hospital over the home, mostly because of concerns around the evening and night period when the NP was not available. Informal caregivers reported overall satisfaction with the HITH program, preference for the hospital, and concerns over receiving care when the NP was unavailable.
Nurse practitioners felt that patients received very good quality care and that the program met the needs of the patients. Hospital physicians as well as family physicians of patients reported high satisfaction with the program and with the nurse practitioner's performance. Some physicians reported making a few phone calls to the patient during the study period with the median time spent being 5 minutes per patient. Nearly 90% of physicians reported that the HITH program affected their practice routine in a positive way. Physicians stated that the impact of the HITH program on their workload was minimal.
Over the 18 month study period, 37 patients completed the program. The most common diagnoses included chronic obstructive pulmonary disease, cellulitis, diabetes, and congestive heart failure. At the time of admission into the program 56% of patients expressed their health as "fair" or "poor".
Conclusions: In this study, the hospital in the home program delivered by NPs was acceptable to patients, informal caregivers, and health care providers. The impact of the program on the physician's workload was minimal. These results suggest that providers and recipients of care may be prepared to accept the hospital in the home program that relies on nurse practitioners as primary care providers as a viable option for receiving health care services outside of traditional care settings.
Reference: Lemelin J, Hogg WE, Dahrouge S, Armstrong CD Martin CM, Zhang W, Dusseault J, Parsons- Nicota J, Saginur R, Viner G. "Patient, informal caregiver and care provider acceptance of a hospital in the home program in Ontario, Canada." BMC Health Services Research 2007; 7, 130.
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