Home Treatment Of Patients Research Articles

Healthcare resource utilisation and associated costs after low-risk pulmonary embolism: pre-specified analysis of the Home Treatment of Pulmonary Embolism (HoT-PE) study.

Pulmonary embolism (PE) and its sequelae impact healthcare systems globally. Low-risk PE patients can be managed with early discharge strategies leading to cost savings, but post-discharge costs are undetermined. To define healthcare resource utilisation and overall costs during follow-up of low-risk PE. We used an incidence-based, bottom-up approach and calculated direct and indirect costs over 3-month follow-up after low-risk PE, with data from the Home Treatment of Patients with Low-Risk Pulmonary Embolism (HoT-PE) cohort study. Average 3-month costs per patient having suffered low-risk PE were 7029.62 €; of this amount, 4872.93 € were associated with PE, accounting to 69.3% of total costs. Specifically, direct costs totalled 3019.33 €, and of those, 862.64 € (28.6%) were associated with PE. Anticoagulation (279.00 €), rehospitalisations (296.83 €), and ambulatory visits (194.95 €) comprised the majority of the 3-month direct costs. The remaining costs amounting to 4010.29 € were indirect costs due to loss of productivity. In a patient cohort with acute low-risk PE followed over 3months, the majority of costs were indirect costs related to productivity loss, whereas direct, PE-specific post-discharge costs were low. Effective interventions are needed to reduce the burden of PE and associated costs, especially those related to productivity loss.

PB0462 Early Discharge and Home Treatment of Patients with Acute Pulmonary Embolism in the Tertiary Care Setting

PB0462 Early Discharge and Home Treatment of Patients with Acute Pulmonary Embolism in the Tertiary Care Setting

Early discharge and home treatment of patients with acute pulmonary embolism in the tertiary care setting

Acute pulmonary embolism (PE) is a potentially life-threatening disease. Current guidelines suggest risk-adapted management. Hospitalization is required for intermediate- and high-risk patients. Early discharge and home treatment are considered safe in the majority of low-risk patients. In this study, we describe characteristics, discharge, and outcome of outpatients diagnosed with acute PE at a tertiary care center. All outpatients undergoing computed tomography pulmonary angiography or ventilation/perfusion lung scan between 01.01.2016 and 31.12.2019 at the University Hospital Vienna, Austria, were screened for a PE diagnosis. Electronic patient charts were used to extract characteristics, clinical course, and outcomes. Within the 4-year period, 709 outpatients (median age: 62 years, 50% women) were diagnosed with PE. Thirty-three (5%) patients were classified as high-risk, 159 (22%) as intermediate-high, 332 (47%) as intermediate-low, and 185 (26%) as low-risk PE according to the European Society of Cardiology risk stratification. In total, 156 (22%) patients (47% with low-risk and 20% with intermediate-low-risk PE) were discharged as outpatients and received home treatment. Rates for home treatment increased 2.4-fold during the study period. Thirty-day mortality in the entire population was 4.9%. All low-risk patients and all but one patient with home treatment survived the first 30 days. Home treatment significantly increased over time and seems to be safe in routine clinical practice. Notably, one in five intermediate-low-risk patients was discharged immediately, suggesting that a subpopulation of intermediate-low-risk patients may also be eligible for home treatment.

Outpatient diagnostics and home treatment of patients with prostate diseases

Outpatient diagnostics and home treatment of patients with prostate diseases

Home Treatment of Patients with Pulmonary Embolism: A Single Center 10-Year Experience from Ljubljana Registry.

Current guidelines suggest careful risk stratification using a structured clinical approach when selecting patients with pulmonary embolism (PE) for home treatment. The aim of our study was to assess whether PE patients referred to home treatment are appropriately risk-stratified according to guidelines prior to referral and what the real-life course of the disease in these patients is. We included patients with confirmed PE referred to outpatient management and treated with anticoagulants between 2010 and 2019, whose data were collected in a prospective management registry. Using simplified PE severity index and/or signs of right ventricular strain, we classified patients to either appropriate or inappropriate low-risk classes for outpatient management. We compared 30-day mortality, overall mortality, and rates of recurrent thromboembolism or major bleeding between both classes. Among 278 patients, 188 (67.6%) and 90 (32.4%) were classified as appropriate or inappropriate class, respectively. In total, 30-day mortality was low in both groups: 0% in appropriate class and 1.1% in inappropriate class. The overall mortality rate was higher in the inappropriate than in the appropriate class (12.1 vs 0.9/100 patient-years, respectively, P < .001). Rates of recurrent thromboembolism and major bleeding were similar for both classes. We conclude that in real-life, a significant proportion of inappropriate low-risk class PE patients are referred to outpatient management. However, with careful follow-up, early mortality is low, even in home-treated patients inappropriately classified as low-risk.

Combating coronavirus disease 2019 at home

Context Our study follows 34 patients during their home treatment after being diagnosed with moderate-severe coronavirus disease (COVID). The home treatment was chosen by the patients and their caregivers after being informed of the risks. Aim To evaluate the outcome of home treatment in patients with moderate to severe COVID who opted for home treatment instead of hospital admission. Patients and methods The retrospective study was conducted among patients diagnosed with SARS COV-2 with moderate to severe COVID who presented to our health care facility. We followed the patients from the initial diagnosis till the time of complete recovery. Results Overall, 87.5% of our moderate to severe COVID-infected patients were able to return to a full bill of health without the need for hospitalization. Age, BMI, or the presence of any comorbidity did not have a significant effect on the time till recovery or need for hospitalization in our sample. Majority of moderate to severe patients were not shown to need any hospitalization. Conclusion This sheds light on the fact that most moderate to severe COVID-infected patients may not require hospitalization and can be effectively managed at home under the supervision of a physician.

Home treatment of patients with cancer-associated venous thromboembolism – An evaluation of daily practice

BackgroundHome treatment of cancer-associated venous thromboembolism (VTE) is challenging due to the high risk of adverse events. While home treatment is quite agreeable to cancer patients, studies evaluating the safety of VTE home treatment in this setting are largely unavailable. MethodsThis was an observational study in patients with cancer-associated VTE. The main outcomes were the proportion of patients treated at home (hospital discharge <24 h after diagnosis) and the 3-month incidence of VTE-related adverse events (major bleeding, recurrent VTE and/or suspected VTE-related mortality) in patients managed in hospital versus at home. ResultsA total of 183 outpatients were diagnosed with cancer-associated VTE: 69 had deep vein thrombosis (DVT) and 114 had pulmonary embolism (PE ± DVT). Of those, 120 (66%) were treated at home; this was 83% for patients with DVT and 55% for patients with PE (±DVT). The 3-month incidence of any VTE-related adverse event was 13% in those treated at home versus 19% in the hospitalized patients (HR 0.48; 95%CI 0.22–1.1), independent of initial presentation as PE or DVT. All-cause 3-month mortality occurred in 33 patients treated as inpatient (54%) compared to 29 patients treated at home (24%; crude HR 3.1 95%CI 1.9–5.0). ConclusionsTwo-third of patients with cancer-associated VTE - including PE - were selected to start anticoagulant treatment at home. Cancer-associated VTE is associated with high rates of VTE-related adverse events independent of initial in hospital or home treatment. However, home treatment may be a good option for selected patients with cancer-associated DVT or PE.

Home treatment of acute pulmonary embolism: state of the art in 2018.

Historically, because of the necessity of parenteral anticoagulation, patients with acute pulmonary embolism are hospitalized until stable oral anticoagulation is achieved. Despite improvements in prognostic risk stratification and the introduction of the direct oral anticoagulants, home treatment is still not widely applied. Main advantages of home treatment involve improvement of quality of life and significant healthcare cost reduction. In this review, we summarized recent published data on home treatment of patients with acute pulmonary embolism. Although a significant decrease in mean duration of hospital admission for pulmonary embolism has been demonstrated over the last decade in Europe, most pulmonary embolism patients are currently hospitalized while they might be treated in an outpatient setting. In recent years, five major studies have been performed, in which the decision to initiate home treatment was based on the Hestia criteria in most patients. Over 98% of patients treated at home had an uncomplicated course. Home treatment of acute pulmonary embolism is suggested to be feasible and safe in 30-55% of all patients. Results of ongoing trials will provide more insight in the optimal strategy to select patients with pulmonary embolism who are eligible for home treatment and likely will result in more widespread application of this practice.

Erratum to Barco et al. "Home treatment of patients with lowrisk pulmonary embolism with the oral factor Xa inhibitor rivaroxaban. Rationale and design of the Hot-PE Trial" (Thromb Haemost 2016; 116: 191-197).

[This corrects the article DOI: 10.1160/TH16-01-0004.].

Assessment-based Home Treatment for People with Schizophrenia Spectrum Disorder

Introduction There is a growing evidence for clinical effectiveness of Home Treatment for patients with severe psychotic disorders . Here we present the development and implementation of a manualised assessment-based Home Treatment in Germany. Objectives We compared the 6-month effectiveness of an assessment-based Home Treatment in patients with schizophrenia spectrum disorder to standard care in a catchment area design. Aims The primary outcome criteria was the rehospitalisation rate. Secondary outcomes comprised improvement of symptoms, functioning, quality of life, medication adherence and satisfaction with care. Methods Assessments were carried out at baseline and at 3 and 6 month. Inpatient admission and treatment contacts were assessed from the hospital database. Results We visited 20 patients with severe psychotic disorder (ICD10: F2.x) almost 400 times in twelve months. The median was 15.5 visits per patient. The intervention resulted in a highly significant reduction of the rehospitalisation rate (−51%, P Conclusions Applying assessment-based Home Treatment for patients with severe psychotic disorders is an alternative treatment compared with standard care resulting in a significant lower rehospitalisation rate with an equivalent clinical outcome.

Home treatment of patients with small to medium sized acute pulmonary embolism.

Most patients with acute pulmonary embolism (PE) are still treated as inpatients. This is a retrospective cohort study of patients with acute PE, diagnosed using V/P SPECT between 2007 and 2011. Patients were treated at home if they were hemodynamically stable, did not require oxygen or parenteral analgetics, had no contraindications to anticoagulant treatment and V/P SPECT showed an extension of the PE of less than 40%. The aim of the study was to evaluate the efficacy and safety of home treatment with our algorithm. During the study period 416 outpatients were diagnosed with acute symptomatic PE of whom in total 260 (62.5%) were discharged home from the emergency unit and another 47 (11%) within 24 h from admission. During 3 months follow-up one (0.3%) patient had a recurrent thrombotic event. Eleven (3.6%) patients had a major or clinically relevant bleed and the overall mortality was 2% (n = 6). There were no PE-related mortality. Home treatment should be considered and is safe in the majority of hemodynamically stable outpatients with small to medium size PE, quantified using V/P SPECT.

Home treatment of patients with acute cholecystitis

Background Patients with acute cholecystitis are treated in Hospital. The aim of the study was to analyze the security and efficacy of treating not-operated-on patients with acute cholecystitis in Hospital in the Home (HIH). Methods Prospective study from January 2010 to May 2011 including all patients diagnosed with acute cholecystitis, not operated on and without comorbidities admitted to HIH Unit from the Emergency Department Short Stay Unit and Observation Unit. Patients were treated with ertapenem for at least one week. Intravenous treatment was followed by oral therapy to complete 14 days of antibiotic treatment. Patient characteristics, clinical course, need for return to hospital during admission to HIH, and admission to hospital in the month after discharge from HIH are analyzed. Results 25 patients were included. Mean age was 59 years (34–82). Upon arrival to the Emergency Department, all patients suffered abdominal pain, 60% had fever, and 32% vomiting. 48% of patients had a leukocyte count over 13,000 cells/μl. All patients had cholelithiasis and a distended gallbladder. 56% showed thickening of the gallbladder wall. Fluid accumulation around the gallbladder was noted in 16% of the cases. Murphy's sign proved positive in 44%. All patients showed a favorable course. No patient required hospital readmission during stay in HIH or in the month after discharge. All patients expressed their satisfaction with treatment at home. Conclusions Patients with acute cholecystitis and without comorbidities can be safely and effectively treated in HIH after a short monitoring period in hospital.

Subcutaneous immunoglobulin substitution and therapy

Patients with combined primary immunodeficiency or B-cell deficiency with low serum concentration of immunoglobulin G can be efficiently treated with immunoglobulin G concentrates. From the 1950s IgG was used intramuscularly, and from the 1980s intravenous immunoglobulin (IVIG) replacement has become widely available for replacement therapy. Among the potential side effects of IVIG (including anaphylaxis), further disadvantages of IVIG are hospitalization during treatment and varying concentrations of IgG. Over the past ten years, subcutaneous IgG (SCIG) preparations have become reasonable alternatives to IVIG. SCIG given weekly assures a more balanced serum IgG level, side affects are mostly local and temporary; systemic, severe adverse events have not been observed. In addition, SCIG can be used for home treatment of patients which improves their quality of life remarkably.

Why are health authorities concerned about home treatment of patients with sleep apnoea?

<h3>Educational aims</h3> To give an overview of the variability of home treatment for CPAP To give insight into the reason for this variability <h3>Summary</h3> Although individual costs are low, the long-term treatment of patients with sleep apnoea has a large overall cost. In trying to assess the economic price of treatment of these patients, authorities need to consider many different aspects of the treatment, including the diagnosis, indications and patient compliance. However, this is complicated by the variability within these aspects. Although the number of patients has seen a steady increase, variability in diagnosis is dictated by efficient management of waiting lists. Variability of indications is more difficult to explain, although differences in diagnostic criteria and provision of service may have influence here. Finally, variability in compliance is a key aspect and must be considered during prescription of treatment.

Nursing practice with intravenous antibiotic home treatment for patients with cystic fibrosis – a Scandinavian Nurses Specialist Group – CF study

Nursing practice with intravenous antibiotic home treatment for patients with cystic fibrosis – a Scandinavian Nurses Specialist Group – CF study

Predicting adverse outcome in outpatients with acute deep vein thrombosis. Findings from the RIETE Registry

Home treatment of patients with acute deep vein thrombosis (DVT) leads to cost savings and improved quality of life. However, little information is known about what influences the clinical outcome in these patients. The Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) is an ongoing registry of consecutive patients with symptomatic, objectively confirmed, acute DVT or pulmonary embolism (PE). In this analysis evaluated the clinical outcome <or=15 days of the start of therapy of all enrolled outpatients with acute DVT in the lower limbs. During the study period, 124 (2.8%) of 4405 DVT patients had at least one adverse event (symptomatic PE, 15; recurrent DVT, 18; major bleeding, 37; death, 68). On multivariate analysis, bilateral DVT, renal insufficiency, body weight <70 kg, recent immobility, chronic heart failure, and cancer were associated with an increased risk for adverse events. When these variables were added into the derivation sample, the area under receiver operator characteristic (ROC) curve was 0.81 (95% confidence interval [CI], 0.76 to 0.86). Patients with a risk score of <or=2 had a 1.2% incidence of adverse events (23 in 1935 patients) compared with the 6.8% incidence in high-risk patients. In the validation sample, the area under ROC curve was 0.79 (95% CI, 0.70 to 0.88). Low-risk patients had a 1.0% incidence of adverse events, and those at high-risk had a 4.7% incidence. A simple risk score based on easily available variables can identify DVT outpatients at low risk for an adverse outcome. This information may help clinicians to decide which DVT patients may be eligible for ambulatory treatment.

Home Treatment in Patients with Hereditary Angiodema (HAE)

Home Treatment in Patients with Hereditary Angiodema (HAE)

Poster 112: The influence of a combination of infrared light with transcutaneous electric nerve stimulation in patients with cervical symptoms of ankylosing spondylitis.

Objective: To study the advantages of a home treatment combination of infrared (IR) light with transcutaneous electric nerve stimulation (TENS) over the classic approach of nonsteriodal anti-inflammatory drugs (NSAIDs) in treating ankylosing spondylitis (AS). Design: Prospective randomized follow-up study. Setting: Academic medical center. Participants: Patients were randomized into 2 groups (20 each). All were men, ages 30 to 40 years old, with cervical symptoms of AS. Interventions: Range of motion of the cervical spine and presence of pain in the neck were evaluated in each group. Patients in both groups underwent kinesitherapy during 2 weeks. Also, group 1 took NSAIDs (7.5mg of meloxicam twice a day), while group 2 had TENS (30min) applied with IR lamp 300W (20min) over the cervical region every morning. Main Outcome Measures: Pain decrease and movement increase. Results: After 2 weeks, in group 1, 60% of the patients experienced a reduction in pain, while 25% experienced an increased amplitude of neck movements. In group 2, 40% experienced a reduction in pain and 75% had a significant increase in neck movements. Conclusions: Application of TENS with an IR lamp is useful and practical in home treatment of patients with cervical symptoms of AS. Also, we must not forget kinesitherapy and NSAIDs, which are a necessary part of treatment.

Outpatient management of venous thromboembolism.

Low molecular weight heparins (LMWHs) have provided the necessary pharmacologic tool to facilitate the outpatient management of selected patients presenting with acute venous thromboembolism. A growing collection of clinical trial results supports the safety and efficacy of this cost-efficient management strategy. However, this approach requires careful patient selection and meticulous care planning. Several randomized multicenter trials have compared a primarily outpatient approach to treating uncomplicated proximal venous thrombosis with a LMWH administered subcutaneously once or twice daily to the inpatient use of unfractionated heparin (UFH). The results have been very encouraging and suggest that the use of subcutaneous LMWH in highly selected, uncomplicated venous thrombosis patients is as safe and effective as intravenous UFH, and that most patients can be treated as outpatient or be discharged early. Irrespective of parenteral anticoagulant approach, warfarin therapy was commenced on day 1 and continued for 3 months. A recent publication by Dedden and colleagues describes a 1-year experience with a pharmacy-managed program for the home treatment of patients presenting with proximal deep vein thrombosis. A plan for coordinated patient care was implemented which included a process for patient referrals, standardized protocol orders, a plan for holding area processing and home healthcare agency follow-up, and subsequent oral anticoagulation management. Results of the program demonstrate a significant healthcare savings (as compared with standard inpatient management) with no significant compromise in patient outcomes. Recently published trials by the Columbus Investigators and Simonneau and colleagues have looked beyond uncomplicated proximal venous thromboembolism to include patients presenting with recurrent venous thrombosis and pulmonary embolism. Results suggest the subcutaneous use of LMWH is as safe and effective as intravenous UFH. Such data begin to lay the scientific foundation for the expanded clinical base of patients who may be candidates for an outpatient management approach. In today's cost-conscience environment, managing the treatment of select venous thromboembolism patients with LMWH(s) and warfarin therapy in an outpatient environment represents an evolving approach that is economically logical, does not compromise patient outcomes, but requires considerable planning to address a myriad of logistical issues.

Approaches towards successful home treatment in patients with inhibitors.

Significant advances have been achieved in prevention of haemophilic disability through prophylactic administration of concentrates and early administration of coagulation factors to control new bleeding episodes, but there is only limited experience with home treatment in haemophilia patients with inhibitors. A home treatment programme using recombinant activated factor VII (rFVIIa; NovoSeven, Novo Nordisk, Bagsvaerd, Denmark) in early intervention against minor bleeds in patients with high responding inhibitors was initiated in Denmark in June 1994. Following careful education and instruction, 2-3 doses each giving 90-100 micrograms/kg bodyweight of rFVIIa were stored in each patient's home. At the onset of a new bleeding episode patients were instructed to inject 1 dose of rFVIIa, and to call the Haemophilia Centre to discuss further management of the episode. If the drug was not completely effective after 1-2 h, a second dose was injected after 3 h. Patients were further instructed to contact us the following day for final efficacy reporting. In total, 7 patients have been enrolled into the study, and to date 114 bleeding episodes have been managed at home with a mean of 2.1 doses per bleed. On 4 occasions, recurrence of bleeding was noted within 24 h. Hospital admission was required in 9 cases, because of a serious injury, insufficient compliance or, in 2 cases, because bleeding required prolonged treatment. Management of these bleeding episodes required a mean of 18 doses. We propose and discuss key criteria for selection of patients for a home treatment programme. The results of this study demonstrate that early intervention in the home setting with rFVIIa is safe and effective in the management of minor bleeding episodes in haemophilia patients with inhibitors.