[Home hospitalization in light of demographic changes and new health challenges]

Today, the most important demographic change taking place is the rapid aging of the population. While this phenomenon is having a growing and profound impact on all spheres of society, its greatest impact is in the health area, affecting all levels of health care and leading to the need for new resources and new structures. Out of that, in many countries have come different alternatives as well as in-patient, outpatient, and in-home programs that are geared toward improving health care and helping set priorities. One of these new initiatives is home hospitalization, or home health care. One objective of this study was to describe and analyze the characteristics of a population in Spain that was assisted through home hospitalization (HH). Another objective of the study was to comment on the role that HH can play as a mechanism for integration and coordination between health care levels, in the face of the challenges occurring with the reorganization of health care policies and programs, especially those directed at the elderly.

A retrospective descriptive study was done of patients assisted through HH in Sanitary Area 9 of the Autonomous Community of Valencia, which is on the eastern coast of Spain. The area's population was 321,361, of whom 60,079 (18.7%) were 60 or older, including 43,044 (13.4%) who were 65 or older. A descriptive study of the analyzed variables was done, with the mean and standard deviation being computed for quantitative variables, and the absolute and relative frequencies (percentages) being calculated for the qualitative variables.

Of the patients studied, 78% of them were 65 or older, with an average age of 73 years. They were predominantly women. Of the total group, 72% of them had chronic diseases, and 67% had at least one associated secondary diagnosis. There was an important problem of communication between the two principal levels of care, primary care and hospital care, which obviously had an impact on the patients and on the quality and effectiveness of their health care. Furthermore, it was found that HH finds its greatest utility with and is an effective tool for an adult or elderly population that has multiple chronic degenerative or terminal diseases.

The results of this study highlight the need to create or strengthen channels and mechanisms for interinstitutional communication that will guarantee continuity of care. The ongoing, effective care of the health and well-being of elderly persons requires different levels of health interventions. This care should be comprehensive, adequate, integrated, of high quality, humanized, timely, and coordinated between the two principal levels of health care. In the final analysis, these factors will determine the quality of the health care for geriatric patients and the capacity to solve their health problems.