RESUMO
An overview of pediatric home care issues reveals the breadth and scope of services available to permit pediatricians to provide care at home. This care option has undergone explosive growth and represents one of the fastest-growing health expenditures. Paradoxically, direct physician involvement in the home has been limited during this expansion because of the way home care has been designed and organized with inadequate reimbursement for physician participation, and lack of awareness by, and education of, physicians concerning their roles and responsibilities. The rationale for physician involvement in home care includes the need for determination and reevaluation of the medical necessity of home care services. Future changes in health care delivery and payment will encourage even more consideration of alternative care sites. Physician participation in program and protocol design will facilitate and encourage the appropriate use of the home as a care setting. For the pediatrician to know about home care requires the development of a curriculum to be implemented in academic centers for physicians-in-training and in professional associations for continuing medical education. This curriculum should enable physicians to become primary participants in home care and should lead to research opportunities to evaluate the benefits of home care.
Assuntos
Serviços de Saúde da Criança/organização & administração , Atenção à Saúde/tendências , Serviços de Assistência Domiciliar/organização & administração , Pediatria/tendências , Papel do Médico , Desenvolvimento de Programas , Criança , Educação Médica Continuada/métodos , Humanos , Pediatria/educaçãoRESUMO
To obtain the physician's perspective concerning their care of children at home who required prolonged life-supportive medical technology, we conducted a mailed survey of 126 physicians caring for 25 children assisted by ventilators who had been discharged from 11 Illinois hospitals to their homes. The 51 (41%) physicians who responded included those practicing in many specialties from a variety of hospital settings throughout Illinois. The majority of respondents had less than 4 years' experience with ventilator-assisted children and were in their earlier years of practice. Most physicians surveyed had participated in discharge planning and maintained an active role with their patients at home after discharge. The majority believed that changes in ventilatory settings could be accomplished in the home and found hospitalization unnecessary for adjustments of the home care prescription. The physicians thought that the roles and responsibilities should be defined for both the tertiary and community-based physician before hospital discharge, and that development and support of resources at the community level were essential for the success of home care.
Assuntos
Atitude do Pessoal de Saúde , Serviços de Assistência Domiciliar , Médicos , Respiração Artificial , Adolescente , Criança , Pré-Escolar , Educação Médica , Humanos , Illinois , Lactente , Privilégios do Corpo Clínico , Equipe de Assistência ao Paciente , Atenção Primária à Saúde , Prática Profissional , Fatores de TempoRESUMO
Eighteen ventilator-dependent children were returned to their homes from Illinois. Each candidate was selected according to physician-designated guidelines for medical stability as well as predetermined social-environmental and reimbursement criteria. Each individualized occurrence was organized according to a comprehensive home care plan. Unanticipated improvement in medical condition and psychosocial development has resulted at home. The children and families have returned to a safe environment that best promotes the health of all involved. In addition, initial cost savings were at least 70%. These demonstrations have evolved into an organized regional approach to the ventilator-dependent child which utilizes available resources. The required continuum of health care and personal services includes intermediate intensive care, respiratory rehabilitation, transitional care, home care, and community-oriented alternatives to home. Problems of the ventilator-dependent child are those encountered by all children with handicaps and their families. The appropriate solutions will provide models for other complex health care and societal issues.