Patient preference and satisfaction in hospital-at-home and usual hospital care for COPD exacerbations: results of a randomised controlled trial

Abstract

Background: In the absence of clear differences in effectiveness and cost-effectiveness between hospital-at-home schemes and usual hospital care, patient preference plays an important role. This study investigates patient preference for treatment place, associated factors and patient satisfaction with a community-based hospital-at-home scheme for COPD exacerbations.

Methods: The study is part of a larger randomised controlled trial. Patients were randomised to usual hospital care or early assisted discharge which incorporated discharge at day 4 and visits by a home care nurse until day 7 of treatment (T+4 days). The hospital care group received care as usual and was discharged from hospital at day 7. Patients were followed for 90 days (T+90 days). Patient preference for treatment place and patient satisfaction (overall and per item) were assessed quantitatively and qualitatively using questionnaires at T+4 days and T+90 days. Factors associated with patient preference were analysed in the early assisted discharge group.

Results: 139 patients were randomised. No difference was found in overall satisfaction. At T+4 days, patients in the early assisted discharge group were less satisfied with care at night and were less able to resume normal daily activities. At T+90 days there were no differences for the separate items. Patient preference for home treatment at T+4 days was 42% in the hospital care group and 86% in the early assisted discharge group and 35% and 59% at T+90 days. Patients' mental state was associated with preference.

Conclusion: Results support the wider implementation of early assisted discharge for COPD exacerbations and this treatment option should be offered to selected patients that prefer home treatment.

Keywords: Chronic Obstructive Pulmonary Disease; Early assisted discharge; Hospital-at-home; Patient preference; Patient satisfaction.