INTERVIEW TRANSCRIPT


My name is Manuel Miron. I'm the head of the Hospital at Home services at Torrejón University Hospital Madrid, Spain. In addition, currently also the president of the Hospital at Home Society in Spain. I'm an internal medicine specialist and I've been working as a doctor in the Hospital at Home field for the last 20 years.

What is the most accepted definition for Hospital at Home (HaH) in your country/ region/society? What words do you use to refer to HaH in your country?

Hospital at Home provides care at home with hospital resources that include human material but also organizational resources. The main objective is substituting the hospital bed for the patient's bed at his or her home. Therefore, if the hospital at home doesn't exist, the patient should remain admitted. For this approach, we use the term home hospitalizations or acute hospital at home. But last year we realized that some patients need care at a hospital level, but not necessarily a hospital bed. Even in a hospital at home, service doesn't exist. For example, for treating onco-hematological diseases with cytostatic drugs, performing blood transfusion, infused, some drugs usually infused at the hospital for patients with chronic conditions and deteriorate, functional status, etc. R. In those cases, we use the wider term of hospital at home. So therefore, the most used words in our country, society are home hospitalization and hospital at home.

How did you get involved with Hospital at Home (HaH) care/model/ecosystem? What is your HaH story?

I started working in the Hospital at Home model of care in 2002. First as an assistant physician. When I finished my specialty at the hospital Joan XXIII de Tarragona, Catalonia, they offered me that position in a moment when the hospital was overcrowded. So, the beginnings for me were not relaxed. And in 2011 I started working in a new hospital as the head of the service in a city near Madrid.

What does a day in your life look like? What motivates you in your work?

We start with a planning session. Nurses and doctors altogether in that session will review the needs of each patient and what we have to do for each of them that day. Then we plan the visit route. Sometimes doctors and nurses visit patients together, sometimes don't. It depends on the patient's needs and features. Then doctors go back to the hospital first, assess the Hospital at Home proposals and make administrative tasks. At the end of the morning, nurses go back to the hospital as well and assess these new patients. In the afternoons, doctors are on call and there is an in-person nursing shift. At weekends, doctors are also on call and nurses visit patients both mornings and afternoons. And at nights we have nurses on call.

And what motivates me, the most important thing, and the reason why I keep on this model of care is to be in contact with the patients, relatives, caregivers in their homes and have the feeling of how beneficial is for them. It's like going back to a traditional way of doing medicine, and that is enriching for us as professionals.

What are the greatest obstacles for the HaH ecosystem and how can we overcome them?

First obstacle, I think, is financial obstacle. Hospital at Home is cheaper than traditional admissions, but even so, Hospital at Home needs to be financed. So, I think this is a politician topic.

Another barrier is the government support. We need this support and regulation rules in order to spread this model of care through the country, through the nations.

We need also professional motivation, which is another barrier with new professionals dedicating their careers to care for patients at home. And in that sense, we have to drive training activities for these new professionals to experience the benefits of this model for the patients and for themselves.

I would say another barrier or obstacle is the coordination between stakeholders. We need to improve the coordination between all actors and stakeholders and also in the private sector between the clinicians and the providers.

What are the most common misconceptions about HaH?

Well, I think Hospital at Home is different from home care related linking to all depending on primary care are completely different. Hospital at Home is not home care service for patients with social needs. It's not a service for follow up patients with chronic conditions and it's not a service for caring for all kinds of palliative patients. Hospital at Home should care only for palliative patients with acute needs like in the hospitals.

What is something about HaH you would like everyone to know?

I would like people and professionals to know that Hospital at Home is good for patients’ healing process or for them to be more comfortable when there is no healing option. It’s cost effective, it's not only cheaper, but also useful for more effective ways of managing resources. And it's also a great opportunity for some professionals frustrated with the way that the medicine provides solution for some patients nowadays. I'm talking about all disabled, vulnerable chronic patients.

What do you think is the value of attending WHAHC 2023?

I think it's a nice opportunity for networking. We need to share our experiences, what is different and what is similar about our models of Hospital at Home. And we can know that by being in contact with professionals from around the world.

It reminds me of the process we have experienced in SEHAD, in the Spanish Hospital at Home society. First sharing experiences among HaH members and professionals and then spreading our model of care to other health professionals and stakeholders.

I'll be very happy if we are able to reach a consensus about HaH definition and or if we are able of finding criteria for classifying the hospital at home activity. And it will be also great if we start working on establishing a skill map for HaH professionals.


Last modified: Monday, 7 November 2022, 11:37 AM