Hospital-at-home and beyond: experiences of patients, caregivers and general practitioners with out-of-hospital care for moderate-to-severe lower respiratory tract infections in older adults—a qualitative study.
Introduction Hospital-at-home (HaH) may help address rising healthcare demands in ageing populations by providing hospital-level care outside the hospital. In the Netherlands, an integrated care pathway (ICP) 'The Hague Respiratory Tract Infection Care Bridge', was developed for adults aged ≥65 year...
| Publicado en: | Age & Ageing Vol. 55; no. 7; pp. 1 - 13 |
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| Autores principales: | , , , , , , , , |
| Formato: | Artículo |
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Oxford University Press / USA
Jul2026
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=195867350&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 195867350 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00020729 AGA jtl: Age & Ageing issn: 00020729 maglogo: N pubinfo: dt: Jul2026 vid: 55 iid: 7 pid: 622 pub: Oxford University Press / USA artinfo: ui: 195867350 10.1093/ageing/afag144 ppf: 1 ppct: 12 formats: tig: atl: Hospital-at-home and beyond: experiences of patients, caregivers and general practitioners with out-of-hospital care for moderate-to-severe lower respiratory tract infections in older adults—a qualitative study. aug: au: Pepping, Rianne M C Vink, Isis Roos, Rick Aken, Maarten O van van den Bos, Frederiek Loor, Gerrit-Dirk de Borgdorff, Hanneke Vos, Rimke C Nieuwkoop, Cees van affil: Department of Public Health and Primary Care; Health Campus The Hague, Leiden University Medical Center, Hippocratespad 21 Building 3, Sixth Floor, Leiden 2300 RC, The NetherlandsInternal Medicine, Haga Hospital, Den Haag, Zuid-Holland, The Netherlands Department of Public Health and Primary Care; Health Campus The Hague, Leiden University Medical Center, Hippocratespad 21 Building 3, Sixth Floor, Leiden 2300 RC, The Netherlands Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden Universitair Medisch Centrum, Leiden, Zuid Holland, The Netherlands Florence, Den Haag, Zuid-Holland, The Netherlands su: Home care services Qualitative research Interviewing Sound recordings Patients' attitudes Psychosocial factors Old age Respiratory infections Research funding General practitioners Severity of illness index Physicians' attitudes Thematic analysis Research methodology Data analysis software Caregiver attitudes Integrated health care delivery Evaluation sug: subj: Home care services Qualitative research Interviewing Sound recordings Patients' attitudes Psychosocial factors Old age Services for the Elderly and Persons with Disabilities Home Health Care Services Offices of All Other Miscellaneous Health Practitioners Offices of all other health practitioners Record Production Sound recording merchant wholesalers Integrated Record Production/Distribution Offices of Physicians (except Mental Health Specialists) Offices of physicians Respiratory infections Research funding General practitioners Severity of illness index Physicians' attitudes Thematic analysis Research methodology Data analysis software Caregiver attitudes Integrated health care delivery Evaluation keyword: aged caregivers copyrightHolder:British Geriatrics Society copyrightYear:2026 emotions family home care services hospital admission hospital at home hospital-based https://dx.doi.org/10.1093/ageing/afag144 inLanguage:en lower respiratory tract infection lower respiratory tract infections older adults organizations patient and healthcare provider experiences physicians publisher:Oxford University Press qualitative research safety sameAs:https://pubmed.ncbi.nlm.nih.gov/42430758/ shared decision making triage aged caregivers copyrightHolder:British Geriatrics Society copyrightYear:2026 emotions family home care services hospital admission hospital at home hospital-based https://dx.doi.org/10.1093/ageing/afag144 inLanguage:en lower respiratory tract infection lower respiratory tract infections older adults organizations patient and healthcare provider experiences physicians publisher:Oxford University Press qualitative research safety sameAs:https://pubmed.ncbi.nlm.nih.gov/42430758/ shared decision making triage ab: Introduction Hospital-at-home (HaH) may help address rising healthcare demands in ageing populations by providing hospital-level care outside the hospital. In the Netherlands, an integrated care pathway (ICP) 'The Hague Respiratory Tract Infection Care Bridge', was developed for adults aged ≥65 years with moderate-to-severe lower respiratory tract infections, offering care through HaH, hospital-at-nursing-home (HaNH) or hospital admission. This study explored experiences with this ICP among the different care settings from the perspectives of patients, informal caregivers and general practitioners (GPs). Methods Semi-structured interviews were conducted with participants across the 3 pathways, including 34 patients, 33 informal caregivers and 7 HaH GPs. Data were analysed using deductive thematic analysis guided by the Consolidated Framework for Implementation Research. Results Three themes emerged from patient and informal caregiver interviews: matching care to needs, shared decision-making and communication, and organisational collaboration. HaH and HaNH were generally seen as positive alternatives to hospitalisation, although feasibility depended on patients' and caregivers' physical and emotional circumstances. Overall satisfaction with care was high. Two themes were identified from GP interviews: practical feasibility and engagement in the HaH-pathway. Overall, GPs supported out-of-hospital treatments, but faced barriers regarding unclear responsibilities, minimal involvement in triage and fragmented communication across providers. Conclusion Delivering hospital-level care outside the hospital for older adults requires context-sensitive, individualised approaches that align with patients' and informal caregivers' circumstances. Perceived safety and acceptability depended on this alignment and on effective organisational collaboration. Sustainable integration of HaH in GP practice requires clear communication pathways and greater involvement in decision-making. These findings provide practical guidance for implementing HaH and HaNH in acute care for older adults. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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