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

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. (C) 2013 Elsevier Ltd. All rights reserved.