Hospital at home compared to in-patient care in exacerbations of COPD: patients’ and carers’ perspectives

Abstract

Background: In a randomised controlled trial, patients admitted to hospital with an exacerbation of COPD were risk-assessed with the DECAF prognostic tool, and low-risk patients assigned to Hospital at Home (HAH) or usual hospital care (UHC). HAH treats patients in their own home by hospital staff, and may improve clinical care and reduce costs, provided it is acceptable to those involved. Method: We aimed to explore patients’ and carers’ experiences of HAH and UHC through semi-structured interviews. Thirty patients were interviewed (15 HAH and 15 UHC) and 14 carers. Thematic analysis was performed as set out by Braun and Clark (2006). Findings: Six themes (including subthemes) are presented. HAH improves patients’ overall well-being (and shortens recovery, provides freedom and improves sleep). HAH facilitates positive relationships between patients and nurses (with respect to personalised relationships and patient/carer information and education). HAH is more convenient for patients (and for visitors and reduces visitors’ costs). Discharge from HAH differs from UHC, manifest by challenges in appropriately discontinuing treatment. HAH is safe. There is a lack of carer-burden with HAH. Discussion: Patients experienced HAH as safe and beneficial to their overall well-being. Counterintuitively, carers of HAH patients did not report an increase in carer-burden and prefer not to relinquish their carer role (though some objected to the term “carerâ€). Of 44 participants interviewed, 41 stated a preference for HAH. Following the national recommendation that the DECAF score be used in all UK hospitals, these results support the national implementation of our HAH model.