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By Ian W. Mac Arthur.
There is one public general hospital in Salvador de Bahia, Brazil, where over one in five of all patients remain longer than fifteen days, and 44% of them linger on for more than a month. Most of them suffer from chronic diseases such as cancers, cerebrovascular disease, diabetes, renal failure and peripheral vascular disease. Not only can extended stays in acute hospital wards present risks for patients, such as nosocomial infections, they may also generate inefficiencies by occupying resource-intensive beds intended for acute patients.
This pattern recurs throughout many countries in Latin America and the Caribbean which, to different degrees, are experiencing the demographic and epidemiological transitions characterized by aging populations and a higher burden of chronic disease. This translates into a growing demand for health services and spending, and thus, these countries are exploring options to achieve a more rational organization of their health care systems.
A solution encountered in several developed countries, such as the United States of America, the United Kingdom and Norway, is known as “intermediate care,” which emphasizes rehabilitation and therapy services that require fewer clinical and technological resources than acute care. Intermediate care has generally intended to:
- Prevent inappropriate admissions to these facilities
- Promote safe and early transitions out of acute hospitals
- Foster independence in community settings.
Meeting these objectives involves applying appropriate procedures to identify eligible patients, exercising rigorous protocols during their transfer, and ensuring their comprehensive assessment and adhesion to a therapeutic plan managed by a multidisciplinary team structured around a core nursing staff.
Although there are several different models for intermediate care on the spectrum from hospital to primary care, and home health is attractive due to its relatively low service costs, many patients will need an institutional, bed-based solution due to clinical characteristics, a lack of family and social support, or low health system capacity at the primary care level. For these individuals, inpatient non-acute facilities, or “intermediate care hospitals” may provide superior outcomes at a lower cost than traditional care on a hospital ward.
The international literature regarding this type of service reveals positive findings on provider and patient satisfaction, clinical outcomes, and cost-effectiveness. Quantitative research involving multiple randomized control trials have shown greater functional independence and reduced hospital readmissions among patients discharged to intermediate care hospitals compared to those remaining on wards in the general hospital.
Therefore, the intermediate care hospital is precisely the type of service chosen by the State Government of Bahia to ameliorate the bed blocking due to long stays by chronic patients in general hospitals. This new service should follow policy guidelines recently established by the Brazilian Ministry of Health regarding “Specialized Hospitals for Prolonged Care,” and the Inter-American Development Bank is supporting this initiative with financing and technical assistance.
Are authorities in your country considering intermediate care as a potential policy approach toward population aging and the increasing burden in chronic disease? Are similar solutions being implemented already? Please share your comments and opinions with us in the comments section or by mentioning @BIDgente on Twitter!
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Ian Mac Arthur is a Lead Specialist in the Social Protection and Health Division at the Inter-American Development Bank.
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