Hospital-in-the-Home Department, The Royal Children's Hospital, Parkville, VIC, Australia; Infectious Diseases Unit, The Royal Children's Hospital, Parkville, VIC, Australia; Clinical Paediatrics Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
Hospital-in-the-Home Department, The Royal Children's Hospital, Parkville, VIC, Australia; Clinical Paediatrics Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
Lancet Infect Dis. 2018 Feb;18(2):e45-e54. doi: 10.1016/S1473-3099(17)30345-6. Epub 2017 Aug 16.
Inpatient management is necessary in many situations, but medical and allied-health treatments are increasingly being used on an outpatient basis to allow patients who would traditionally have been admitted to hospital to remain at home. Home-based clinical management has many potential benefits, including reduced hospital-acquired infections, cost savings, and patient and family satisfaction. Studies in adults provide evidence for the benefits of home-based versus hospital-based intravenous antibiotics, but few studies inform practice in home-based intravenous antibiotic therapy for children. We systematically reviewed the efficacy, safety, satisfaction, and cost of home-based versus hospital-based intravenous antibiotic therapy for acute infections in children. We searched MEDLINE (from Jan 1, 1946, to Jan 31, 2017) and Embase (from Jan 1, 1974, to Jan 31, 2017) for studies investigating home-based and hospital-based intravenous antibiotic therapy and assessed them for quality. 2827 articles were identified and 19 studies were included in the systematic review. Efficacy results differed between studies depending on the outcome assessed. The incidence of complications and readmission to hospital was similar for hospital-based and home-based treatments. In seven (47%) of 15 studies, patients who had all or part of their treatment at home received treatment for longer than patients who were treated entirely in hospital. No studies showed that home-based treatment was less safe than hospital-based treatment. In all studies in which treatment satisfaction or costs were assessed, home-based treatment was satisfactory to patients or patients' families and less expensive per episode than hospital-based treatment by 30-75%. Thus, home-based intravenous antibiotic therapy might be popular and cost-effective, but randomised studies of the efficacy of this strategy are needed. This systematic review was registered with PROSPERO (number CRD42015024406).
在许多情况下需要住院治疗，但越来越多的医疗和联合健康治疗采用门诊治疗，以使传统上需要住院的患者能够留在家里。基于家庭的临床管理有许多潜在的好处，包括减少医院获得性感染、节省成本以及提高患者和家属的满意度。成人研究为基于家庭的与基于医院的静脉内抗生素治疗的益处提供了证据，但很少有研究为儿童基于家庭的静脉内抗生素治疗提供实践依据。我们系统地回顾了基于家庭与基于医院的急性感染儿童静脉内抗生素治疗的疗效、安全性、满意度和成本。我们检索了 MEDLINE（从 1946 年 1 月 1 日到 2017 年 1 月 31 日）和 Embase（从 1974 年 1 月 1 日到 2017 年 1 月 31 日），以调查基于家庭和基于医院的静脉内抗生素治疗的研究，并对其进行了质量评估。共确定了 2827 篇文章，并对其中 19 项研究进行了系统综述。疗效结果因所评估的结局而异。基于家庭和基于医院的治疗的并发症发生率和再入院率相似。在 15 项研究中的 7 项（47%）中，在家中接受全部或部分治疗的患者的治疗时间长于完全在医院接受治疗的患者。没有研究表明基于家庭的治疗不如基于医院的治疗安全。在所有评估治疗满意度或成本的研究中，基于家庭的治疗对患者或患者家属是满意的，且每例治疗的费用比基于医院的治疗低 30%-75%。因此，基于家庭的静脉内抗生素治疗可能是受欢迎且具有成本效益的，但需要进行这项策略疗效的随机研究。本系统评价已在 PROSPERO（注册号 CRD42015024406）注册。
