All of us have heard about the benefits of Home Healthcare: doctors and nurses visit the patients’ homes and deliver care at their doorstep and how it helps people by saving time on hospital visit process, queues etc. These are very obvious but generic discussions.
From a doctor’s perspective, I wish to highlight a couple of examples which I have encountered: these while, from a very practical standpoint, the simple yet elegant benefits of home health care delivery.
I am a practicing oncologist and I treat a lot of people for cancer with chemotherapy. Chemotherapy is an essential part of cancer care and helps in the control and cure of cancer. A patient is given a cycle of chemotherapy, typically over 1 to 3 days, being admitted in a hospital. The chemotherapy causes side effects and one of them is bone marrow suppression and low immunity status to fight infections. Fortunately for us, there are some medications available to us which stimulate patients’ bone marrow to produce white blood cells and combat infections, which otherwise can be fatal. These medications are called GCSF (Granulocyte colony stimulating factor) and are easy to give and are typically given 1 to 3 days after completion of chemotherapy. In this situation, what does the patient do? He/she either stays in hospital for an additional 2 days so that this injection is taken, or the patient goes home and comes back to hospital after 2 days to take this injection.
All of us need to remember that the hospital is the most notorious place to catch an infection. This is called hospital acquired infection or nosocomial infection. Here we have a situation where chemotherapy given is causing bone marrow depression, and the patient either stays in hospital for some extra days or comes back to hospital for a protective injection. Both situations mean that the patient is exposed to nosocomial infections. We are advising patients to avoid catching an infection, but paradoxically exposing the patient to an avoidable hospital environment!.
What can be done to mitigate this conflict? Simply put, get the injection to be done at home by a home nurse!!
Checkout the benefits of doing so:
- Injection is simple to give and can be administered anywhere.
- Patient does not get into hospital to catch infection
A 40 year old home maker called me for help for a sprained back after lifting some heavy object. She has been having niggles in her back for a while now, but the present episode was very painful and debilitating unlike previous times. She had to undergo a consultation by an orthopedic surgeon, investigations like MR/CT scans, and even a couple of days of admission in hospital for pain relief. After that, she was sent home and advised bed-rest. In addition, she was advised physiotherapy for her back for good recovery. Each session of physio takes about 40 minutes: but where does she take the physiotherapy? At a hospital, situated anywhere between 10 to 25 kilometers from home, travelling in an autorikshaw on bumpy roads, to reach the physiotherapy department to take a physio session; imagine this process being repeated for 10 sittings!! Remember, all the while in the hospital, she is reminded she should take bed-rest. She goes back in another autorikshaw to her house, because physiotherapy is an out- patient procedure. We can imagine the plight of this lady’s back, in spite of the physiotherapy after 10 days? Where is the strict bed-rest being adhered?
Here lies the other paradox. The healing would be a lot comfortable, better and faster if the same physiotherapy was delivered to her for 10 days prescribed in the comfort of her home, on her bed, watching her favorite serial!
This is how we complicate our lives.
The solution is very simple – Home physiotherapy will make all the difference.
The more we look at medical problems today, the more we realize, especially me as a doctor, that at least 40% of people whom we see in a multi-specialty, tertiary care hospital need not be seen there, but can be seen at home as adequately illustrated above.
Does that mean the hospital stands to lose out? No!! . Herein lies another paradox. The time saved by these home care patients by restricting their visits to the hospitals can be optimally used by the senior specialists in these hospitals to treat really complicated and life threatening illnesses. These serious patients may not be seen on time in the OPD, as the hospital is “cluttered” with the 40% home care patients!
I believe this is how we can optimize hospital care in particular and healthcare in general today, by a judicious mix of carefully chosen hospital and home care cases.
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