[Specialized home care for infectious disease. Experience from 1995 to 2002].
OBJECTIVE
In 1995 a specialized home care service for infectious diseases was created in our institution. The aim was to improve the quality of life of patients with prolonged parenteral antimicrobial therapy requirements, reduce the length of hospital stay, and improve the care received after discharge by clinical and analytical surveillance. This study reviews the experience of this service from 1995 to 2002 using prospectively recorded data.


METHODS
An analysis was performed of the number of patients included in the home care program per year, number of patients with HIV infection, infectious disease diagnosed, department referring the patient, antimicrobial treatment administered, destination at discharge, and reason for hospital re-admission.


RESULTS
The number of patients included each year from 1995 to 2002 was 52, 55, 77, 232, 213, 321, 280 and 219, respectively. The percentage of HIV-infected patients decreased from 90% in 1995 to 23% in 2002. The main reason for referral to the program changed from substitution of day-care hospital treatment to early discharge from hospitalization. Whereas CMV infection was the most frequent infection treated during the 1995-1998 period, bacterial infections predominated in the following years. In 148 episodes, self-administration or a portable infusion pump was used for drug administration. Self-administration was associated with a greater risk of complications (24% vs. 12%, OR 2.3, 95% CI 1.5-3.6, P < 0.001) and catheter-related sepsis (4% vs. 0%, OR 12.9, 95% CI 10.9-15.3, P < 0.001). HIV-infected patients were re-hospitalized due to complications unrelated to the home care service more frequently than HIV-uninfected patients.


CONCLUSIONS
The percentage of HIV-infected patients included in the infectious disease home care service has progressively decreased since 1996, a fact likely to be related to the introduction of highly active antiretroviral therapy and better control of opportunistic infections. Currently, bacterial infections are the most frequent infections treated in the service. Early hospital discharge is now the main reason for referral to the home program.
Horcajada
Juan Pablo
JP
Servicio de Enfermedades Infecciosas, Hospital Clínic - IDIBAPS, Universidad de Barcelona, IDIBAPS: Institut d'Investigacions Biomèdiques August Pi i Sunyer, España.
García
Laura
L
Benito
Natividad
N
Cervera
Carlos
C
Sala
Marta
M
Olivera
Angels
A
Soriano
Alex
A
Robau
Marga
M
Gatell
José M
JM
Miró
José M
JM
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology; D003141:Communicable Diseases / Q000188:drug therapy*; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology; D018575:Home Care Services, Hospital-Based / Q000458:organization & administration* / Q000706:statistics & numerical data; D018718:Home Infusion Therapy / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007260:Infusion Pumps; D007263:Infusions, Parenteral / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011788:Quality of Life; D012189:Retrospective Studies; D012646:Self Administration; D013030:Spain / Q000453:epidemiology
D000890:Anti-Infective Agents