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 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.