Home Care NetWork
Home Care Literature Review: July - December 2006
Infectious Disease:
Labarere J, Stone RA, Scott Obrosky D, Yealy DM, Meehan TP, Auble TE, Fine JM,
Graff LG, Fine MJ. Factors associated with the hospitalization of low-risk patients with community-acquired pneumonia in a cluster-randomized trial. J Gen Intern Med 2006; 21:745-752
This database analysis of the records of 889 low-risk patients (Pneumonia Severity Index [PSI] risk classes I to III without evidence of arterial oxygen desaturation) enrolled in a cluster-randomized trial conducted in 32 emergency departments found that 44.7% of all low-risk patients were treated as inpatients. Factors independently associated with an increased odds of hospitalization included PSI risk classes II and III, the presence of medical or psychosocial contraindications to outpatient treatment, comorbid conditions that were not contained in the PSI (cognitive impairment, history of coronary artery disease, diabetes mellitus, or pulmonary disease), multilobar radiographic infiltrates, and home therapy with oxygen, corticosteroids, or antibiotics before presentation. A total of 32.8% of low-risk inpatients had a contraindication to outpatient treatment, and 47.1% had one or more preexisting treatments, comorbid conditions, or radiographic abnormalities not contained in the PSI; 20.1% had no identifiable risk factors for hospitalization other than PSI risk class II or III. This study indicates that 20% of low-risk community-acquired pneumonia patients were admitted, despite criteria suggesting that they could have been successfully treated at home. Physicians concerns, or ignorance of the role of home care in community acquired pneumonia, are still important factors. This shows that we still have a way to go in terms of appropriately managing these patients.
Hirdes JP, Dalby DM, Steel RK, Carpenter GI, Bernabei R, Morris JN, Fries BE.
Predictors of influenza immunization among home care clients in Ontario. Can J Public Health 2006; 97:335-339
This Canadian prospective case series evaluated factors associated with the receipt of influenza vaccination among Ontario home care clients. The overall rate of immunization approached 80%. Age, respiratory problems, diabetes, and congestive heart failure were associated with greater immunization rates while low education, smoking, and poor medication adherence were negatively associated with influenza immunization. These factors may be predictable but should inform strategies or immunization of at-risk populations of homebound patient. There is no reason to believe that this experience would not be similar in the United States.
Nazer D, Abdulhamid I, Thomas R, Pendleton S. Home versus hospital intravenous antibiotic therapy for acute pulmonary exacerbations in children with cystic fibrosis. Pediatr Pulmonol 2006; 41:744-749
This retrospective case series of 143 encounters for pulmonary exacerbations in 50 patients with cystic fibrosis compared encounters treated with inpatient antibiotics (n = 64) with encounters treated with IV antibiotics at home (n = 79) and found no significant differences in outcome variables at baseline but the hospital encounters demonstrated significantly greater improvement in FEV1 and a shorter duration of treatment as compared to home treatment encounters. The outcomes were good for both types of encounters in this uncontrolled retrospective review, but cost and patient preferences were not measured. This remains an area ripe for further research.
Home Care Literature Reviews 2004
Infectious Disease:
Morrison J; Health Canada, Nosocomial and Occupational Infections Section. Development of a resource model for infection prevention and control programs in acute, long term, and home care settings: conference proceedings of the Infection Prevention and Control Alliance. Am J Infect Control. 2004;32:2-6.
This Canadian clinical position statement is based on an analysis of the impact of health care restructuring on the provision of infection prevention services in the Canadian health care system that resulted from two meetings of Canadian infection control experts. This group determined needs at a level of three full time equivalent infection control professionals/500 beds in acute care hospitals and one full time equivalent infection control professional/150-250 beds in long term care facilities. Community and home care settings did not require increases professional manpower but non-human resource requirements were described. This is an interesting planning report with some relevance for infection control in home care in the U.S.
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