Hospital at home:not the only alternative to district general hospital care
The useful papers comparing hospital at home with inpatient hospital care published in 13 June journal1-4 did not consider another possible lower cost option to acute District General Hospital (DGH) care; namely that of community hospital care. There are approximately 450 community hospitals in the UK with the majority of beds being General Practitioner (GP) led (data on file, Community Hospitals Association). The recognised roles of such hospitals include general medical care, rehabilitation following falls, strokes and orthopaedic and general surgery. There is evidence of good quality care and carer satisfaction in community hospitals5 and a cost analysis performed indicated that community hospital beds cost between 1/3 and ½ of that of a DGH bed6. The advantages of community hospitals are the proximity to the patients home7, the low technology environment which patients find less intimidating, the continuity of care provided by their own general practitioner and Primary Health Care Team (PHCT) and hospital staff who are often known to the patients and carers alike5. Before extensive investment in new hospital at home schemes, with the present uncertainties over effectiveness (albeit for certain clinical groups), costs and probable increase burden on the PHCT, it would be wise to run comparative studies using community hospital facilities that are already present and have a long-standing track record in the type of medicine targeted for hospital at home schemes.
David A Seamark
Clare J Seamark
General Practitioners, and Committee Members of the Community Hospitals Association.
The Honiton Group Practice, Marlpits Road, Honiton EX14 8DD.
1) Shepperd S, Harwood D, Jenkinson C, Gray A, Vessey M, Morgan P. Randomised controlled trial comparing hospital at home with inpatient hospital care. I: three month follow up of health outcomes. BMJ 1998;316:1786-91.
2) Shepperd S, Harwood D, Gray A, Vessey M, Morgan P. Randomised controlled trial comparing hospital at home with inpatient hospital care II: cost minimisation analysis. BMJ 1998;316:1791-6.
3) Richards SH, Coast J, Gunnell DJ, Peters TJ, Pounsford J, Darlow M-A. Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care. BMJ 1998;316:1796-801.
4) Coast J, Richards SH, Peters TJ, Gunnell DJ, Darlow M-A, Pounsford J. Hospital at home or acute hospital care? A cost minimisation analysis. BMJ 1998;316:1802-6.
5) Seamark DA, Williams S, Hall M, Lawrence CJ, Gilbert J. Dying from cancer in community hospitals or a hospice: closest lay carers' perceptions. Br J Gen Pract 1998;48:1317-21.
6) HACAS Financial management and strategy in community hospitals. Report to the Department of Health. May 1991.
7) Seamark DA, Williams S, Hall M, Lawrence CJ, Gilbert J. Palliative terminal cancer care in community hospitals and a hospice: a comparative study. Br J Gen Pract 1998;48:1312-6.
Competing interests: No competing interests