Health

19 Jan 09

Older patients who receive medical care at home do just as well as those admitted to hospital

Older patients who receive medical care in their own homes do just as well as those admitted to hospitals, a new study led by University of Oxford researchers has found. Furthermore, such ‘hospital at home’ programmes can be provided at similar or lower costs.

Hospital at home programmes avoid admitting clinically stable patients to hospital wards by providing full medical support in the patient’s own home. The schemes are popular alternatives to hospital stays for older people, among both the patients themselves and those responsible for managing hospitals.

The increasing demand for acute care beds and the need to cut costs as well as the potential benefit to the patient of rehabilitating at home, makes hospital at home an attractive alternative to being treated in hospital. However, it was not previously known if the patients have better, or worse, health outcomes as a result.

The British and Italian researchers carried out a study to determine whether patients receiving at-home care have better or equivalent health outcomes compared with inpatient hospital care. The findings are published in the Canadian Medical Association Journal and the Cochrane Library, the database of evidence-based healthcare studies.

The study included data from 10 trials involving more than 1300 patients with an average age above 70. Patients in the research had chronic obstructive pulmonary disease, were recovering from a stroke or were older patients with an acute medical condition.

‘We found no evidence that hospital at home care leads to an increase in mortality for these patient groups,’ says Dr Sasha Shepperd of the Department of Public Health, University of Oxford. ‘Patient satisfaction was also higher for treatment at home.’

Patients on hospital at home programmes were less likely to have died by the time of their six months follow up than those admitted to hospital. This reduction could not be picked up at 3 months.

However, in the case of stroke patients, mortality rates were found to be lower at three months for patients who went into a hospital stroke unit compared to those who had hospital at home care.

‘Our findings do not mean that hospital care is hazardous,’ cautions Dr Shepperd who led the team of researchers. ‘More work needs to be done to determine if there are particular types of patient who benefit from hospital at home care. This is especially important as the level of treatment available to a person at home, and the ways of delivering care in both the home and the hospital, change over time.’

Professor Mike Clarke from the UK Cochrane Centre adds: ‘Our findings represent the most complete analysis yet of this topic and provide important knowledge for patients, doctors and policy makers.’