INTERVIEW TRANSCRIPt


My name is Vittoria Tibaldi. I'm a medical doctor from Italy specialized in geriatrics. I work in Turin at the Hospital at Home service in the geriatric unit at the City of Health and Science, which is a big university teaching and tertiary care hospital in Turin.

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?

In Italy, there are very few hospitals that offer this service, and they use the term Hospital at Home, meaning a service that provides active treatment by health care professionals in the patient's home of a condition that otherwise would require acute hospital inpatient care. I usually describe Hospital at Home as an alternative to traditional hospital care for selected patients with an acute disease or an exacerbation, or decompensation of chronic diseases requiring hospital care, but not primary care. That means Hospital at Home is the delivery of acute hospital level care to selected ill people at home. For example, suitable patients are patients in need of diuretics IV for an acute decompensation of heart failure or antibiotics for an infection.

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

I started my experience with Hospital at Home when I was a student at the university. During my studies approximately 25 years ago, I encountered this service that was already operating at the above-mentioned hospital in Turin where I'm still working, I like the idea of treating people at home and not in a traditional hospital world. My thesis described the treatment of the treatment at home of elderly patients affected by acute uncomplicated ischemic stroke, and this was also the argument of my first published paper. I continued working in Hospital at Home all through my specialization in geriatrics, and at that time the manager of the Hospital at Home was Dr. Nicoletta Aimonino, who introduced me to the joy of this kind of work and to research. I think that for me, Hospital at Home was really like love at first sight.

What does a day in your life look like?

I shall try to describe one of my typical working days. I normally wake up at six in the morning and after an hour's drive I reach my workplace around eight. The morning is dedicated to visiting patients that are hospitalized at home. Usually, I visit my patients together with a nurse. In the afternoon, I deal with the bureaucracy, for example, writing discharge letter, checking the results of laboratory tests performed in the morning, or reviewing the needs of each patient in order to decide what to do for each of them that day or the day after. Then, if I have the time, I do some researching, teaching, or training.

What motivates you in your work?

What motivates me to keep going on in my work is to do something that can be useful and satisfying for a very frail part of population, as our elderly patients are. The satisfaction that patients and their families often express makes me aware that I made the right choice. Working outside the comfort zone of the hospital is challenging but also very stimulating, and this satisfies me and motivates me a lot.

Can you share a story from your time working in HaH?

I have many good memories related to my work. Families who offer you coffee and cake or something to drink during the visit at home. Patients who tell you about their youth and show you photos of their wedding or their family. Families who years later call for Christmas greetings. I think that the positive and beautiful aspect of this work is that often we create with our patients and their families bonds and stories. And I think this is a way of being a doctor that I find very human, and this is what satisfies me and motivates me to do this kind of work.

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

One obstacle, I think, is defining the Hospital at Home as a model of care and its clinical characteristics. There is still a lot of variation in the hospital at home model of care across the countries, and this limits the possibility of making comparison and examining the generalized ability of research findings. Another obstacle is the definition in selecting patients for Hospital at Home care, how to select patients and who is a matter of great importance. A third obstacle, I think, is the need to have another great family and or environmental context at home for the Hospital at Home service to work. A third obstacle is to overcome the perplexities and the doubts of colleagues working in our setting of care. It's important to make it clear that many pathologists today can be treated at home with results comparable to those obtained in the hospital. If we can obtain our colleagues trust, it's easier to collaborate and share patient care. Moreover, it's an obstacle to overcome perplexities and doubts of those involved in the organization of health services and politicians. We need government support for the service to spread in other countries and worldwide.

And finally, I think another important barrier is the financial one. Hospital at Home needs a specific budget, and this issue requires a specific attention from politicians. I think that the only way we have to overcome these obstacles is to continue intense research activity. Only a solid evidence-based Hospital at Home activity can favor the implementation of this model of care. From this point of view, I think that could be useful to extend our interest also to research comparing different Hospital at Home service models. Studies involved in different countries could be an attempt to overcome hospitals to Hospital at Home implementation.

What are the most common misconceptions about HaH?

I think it's not easy to answer this question because the concept of Hospital at Home is not very known, at least in Italy. So many people, especially in Italy, don't really have any misconception about this model of care. I think that one of the most common misconceptions among the people that know a little about the concept of Hospital at Home is to compare Hospital at Home to primary care or to other health community services which have instead a lower intensity of care. Other common misconceptions are to think that Hospital at Home is too complex, either too selective or too expensive to realize.

Moreover, many people think that the Hospital at Home is too burdensome for families. But the research data tell us that this is not really so. Studies show better patient and caregiver experience and similar or less caregiver stress in Hospital at Home. Families, if supported really like this type of care. More research is needed to understand the role of family and caregivers better and how we can train and support families and caregivers in their daily duties.

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

I think that the most important thing would be to increase the knowledge of Hospital at Home, and this is a big issue in my opinion. More and more people should know what Hospital at Home is and what Hospital at Home can do. I also think it's important to explain to people that traditional hospital is sometimes a risky setting of care for special population, for example, frail or elderly people.

Hospitalization at home can be a feasible and effective alternative for these patients. Furthermore, it's important to assure people about the safeness of this model of care for acute selective diseases. Another thing would be to assure those involved in the organization of health services and politicians that Hospital at Home is a safe, effective, and well accepted model of care for selected patients and with a potential positive impact on cost, that is to say, a good investment for the future, especially considering the aging of the population.

What are you looking forward to at the upcoming WHAHC 2023?

I would very much like to hear about a new experience from other countries in the world and to make comparisons with other Hospital at Home models. I would also like to understand if and how COVID-19 has boosted this model of care worldwide. In order to understand why this didn't happen in Italy, I would like to know what the possible innovations for the future, especially in the technological field and in research could be. Furthermore, I would like to create some kind of collaborations with colleagues, if possible, and last but not least, to meet old friends with whom I have been trying for years to spread the knowledge of this model of care worldwide.


Last modified: Monday, 6 February 2023, 12:11 PM