Informal caregiver strain, preference and satisfaction in hospital-at-home and usual hospital care for COPD exacerbations: results of a randomised controlled trial.
BACKGROUND
Informal caregivers play an important role in hospital-at-home schemes. However they may increase their burden, especially chronic diseases, like COPD. In the absence of clear differences in effectiveness and cost-effectiveness between hospital-at-home and usual hospital care, informal caregiver preferences play an important role. This study investigated informal caregiver strain, satisfaction and preferences for place of treatment with a community-based hospital-at-homes scheme for COPD exacerbations.


METHODS
The study was part of a larger randomised controlled trial. By randomisation, patients were allocated to usual hospital care or hospital-at-home, which included discharge at day 4 of admission, followed by home treatment with homes visits by community nurses until day 7 of treatment. Patients allocated to usual hospital care received care as usual in the hospital and were discharged at day 7. Patients were asked if they had an informal caregiver and who this was. Patients and their caregivers were followed for 90 days. Informal caregiver strain was assessed with the caregiver strain index. Satisfaction and preference were assessed using questionnaires. All measurements were performed at the end of the 7-day treatment and the end of the 90-days follow-up.


RESULTS
Of the 139 patients, 124 had an informal caregiver, of whom three-quarter was the patients' spouse. There was no significant difference in caregiver strain between hospital-at-home and usual hospital care at both time points (mean difference at T+4 days 0.47 95% CI -0.96 to 1.91, p=0.514; mean difference at T+90 days 0.36 95% CI -1.85 to 1.35, p=0.634). At the end of the 7-day treatment, 33% (N=15) of caregivers of patients allocated to hospital treatment and 71% (N=37) of caregivers of patients allocated to home treatment preferred home treatment, if they could choose. Caregivers were satisfied with the treatment the patient received within hospital-at-home.


CONCLUSIONS
There were no differences in caregiver strain between the community-based hospital-at-home scheme and usual hospital care. Most caregivers were satisfied with the treatment. In addition to other outcomes, our results support the wider implementation of hospital-at-home for COPD exacerbations.
Department of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands; Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands. Electronic address: cecileutens@gmail.com.
Cecile M A
CM
Utens
Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
Onno C P
OC
van Schayck
Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
Lucas M A
LM
Goossens
Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
Maureen P H M
MP
Rutten-van Mölken
Department of Respiratory Medicine, Máxima Medical Centre, Veldhoven, The Netherlands.
Dirk R A J
DR
DeMunck
Department of Respiratory Medicine, Atrium Medical Centre, Heerlen, The Netherlands.
Wiel
W
Seezink
Department of Respiratory Medicine, Atrium Medical Centre, Heerlen, The Netherlands.
Monique
M
van Vliet
Department of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands.
Frank W J M
FW
Smeenk
D000368:Aged; D017028:Caregivers / Q000523:psychology*; D005260:Female; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010549:Personal Satisfaction; D029424:Pulmonary Disease, Chronic Obstructive / Q000451:nursing / Q000628:therapy*; D011795:Surveys and Questionnaires
Caregivers; Chronic Obstructive Pulmonary Disease; Early assisted discharge; Hospital-at-home