(Pediatrics in Review. 1997;18:271-273.)
© 1997 American Academy of Pediatrics
Consultation with the Specialist: Home Care for Children Who Have Chronic Conditions
Gregory S. Liptak, MD, MPH*
*
Associate Professor, Divisions of General Pediatrics and
Developmental Disabilities, University of Rochester School of Medicine and Dentistry, Rochester, NY.
Until the early 1900s, children who were ill were cared for at home and
followed by physicians who made house calls. As technical care improved,
sick children were admitted to hospitals. Then, in the mid-1970s, as the
benefits of care at home were discerned and hospitals reached capacity,
increasing numbers of children began to be cared for at home with high
technology equipment. With the recent escalating pressure to reduce
health-care costs, the growth of medical home care services has exploded.
Home care now includes a wide array of services: administration of
intravenous medications; nutritional support, including enteral feedings and
intravenous nutrition; monitoring for apnea and bradycardia; administration
of supplemental oxygen; nebulization treatments; mechanical ventilation;
phototherapy for hyperbilirubinemia; and rehabilitation/habilitation
services. Although care at home can be cost-saving and provide a convenient,
psychologically beneficial environment for the child, it also can increase
the burden of care on the family (additional demands on time,
responsibilities, and money) and diminish their privacy. The primary care
pediatrician should be as familiar with the process of home care as he or
she is with the process of inpatient care to guide families and coordinate
care of subspecialists.
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General Considerations
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The Table
lists the factors that must be addressed in all patients for whom home care is
considered. The physician should evaluate the appropriateness of the child for
home care, coordinate and monitor health care, help teach the child and family
about the medical condition and its treatment, help train the family in the technical
aspects of care, order the proper equipment and supplies, communicate with other providers
and agencies, and continually monitor the child's status. The nurses who provide the care at . . . [Full Text of this Article]
Copyright © 1997 by the American Academy of Pediatrics.
