Where clinically appropriate, Hospital in the Home (HITH) services deliver benefits to patients and health services. There is scope to significantly expand these benefits by boosting and standardising the role of general practitioners in decision-making process.
HITH provides acute admitted care to public hospital patients in the comfort of their home, or other suitable location. Eligible patients have a condition that requires inpatient care, but which can be treated and managed off-site through regular visits from doctors, nurses and allied health professionals.
Research by Cochrane Australia, published in March 2024, showed that HITH programs reduce service pressure and costs for hospitals, and optimise comfort and stress reduction for patients.
However, the researchers also noted that “the critical need now is to identify and test strategies that can increase the adoption, uptake and sustainability of HITH programs across different healthcare systems – including strategies for engagement of referrers, patients and caregivers, and strategies for process optimisation and sustainability.”
North Western Melbourne Primary Health Network (NWMPHN) believes that a key reform needed to optimise the efficiency of HITH in line with Cochrane’s findings is to clarify and optimise the role of GPs in making referrals.
At present only three of the hospitals servicing the NWMPHN catchment allow GPs to refer patients to HITH services, via consultation with, and triage by, a HITH doctor.
Others require potential HITH patients to be first assessed through emergency department or inpatient services.
This means that even if a GP makes a clinical judgement that a patient has a condition that is suitable for HITH treatment, the patient must nevertheless go through a lengthy, complex hospital experience before the GP’s initial assessment is confirmed.
The three hospitals that allow direct GP referral demonstrate that clear referral guidelines can be developed for specific conditions and consultation with a HITH doctor is an appropriate and clinically valid pathway to admission.
“For the remaining hospitals to adopt similar pathways would seem to be a matter primarily of in-house reorganisation,” said Christopher Carter, NWMPHN’s chief executive officer.
“There do not seem to be any clinical, diagnostic or safety barriers to easing access to HITH for patients by allowing the referral capability of GPs in the process. At a time when hospitals are under increasing pressure, this could be a relatively simple fix.”
Adopting this simpler referral pathway as the default would deliver multiple positive outcomes. The process would be simpler and less time-consuming for patients. Hospital ward and emergency department staff and resources would be freed up.
It would also result in improved information flow between the patient, GP and HITH service provider. This carries additional clinical benefit, given that at the conclusion of the HITH treatment, the patient will return to the care of the GP after discharge.
NWMPHN agrees with Cochrane Australia’s observation that future large, randomised trials will provide more detailed analyses of the clinical and cost-effectiveness of HITH service delivery.
It agrees, too, with the finding that it “is critical for HITH to be a core part of every acute hospital’s care strategy and extend its impact to transform patient care on a larger scale.”
It hopes too that the Medicare Benefits Scheme will be adapted in response to the realities of HITH to allow patients to access their GP during their treatment period.
NWMPHN is currently working with several of Melbourne’s major metropolitan hospitals to raise awareness of the benefits of HITH services. It looks forward to working with the hospitals within its catchment to optimise effective collaboration between general practice and the tertiary care sector to the advantage of patients and clinicians.
