Hospitalización domiciliaria y reorganización de la asistencia hospitalariaLa verdadera reforma pendiente

Resumen

A review is made of the literatura with the aim of addressing home hospitalization in terms of its characteristics and functional dynamics, and of discussing its role in the reorganization of the health care system in the context of its nature as a potencial mechanism form integrating and establishing coordination among different levels. In addition, a contribution is made to the debate of the circumstances that have an impact upon health care management in Brazil in the face of new and future challenges that orientate towards the adoption of shared care model. As regards materials and methods, a review is made of the different studies Publisher and indexed by the Medline and Lilacs (CD-Rom version) bibliographical search databases, together with consultations of the databases of journals of relevante in health care (in English, Spanish and Portuguese) - emphasis being placed on the las 5-year period (1995-2000). The main topics dealt with were the characterization of Home Hospitalization in terms of the professional and patient profiles, pathologies and/or therapeutic procedures, program inclusión criteria, and the benefits frequently attributed to the health services, hospital, patients and relatives, together with the role of Home Hospitalation in the face of the challenge posed by reform of the health system as a whole, and of hospital care in particular. The main findings and conclusions drawn from the reviewed studies show that Home Hospitalization entails the possibility of initiating hospital reform in congruency with that initiated in the primary care setting. As innovative aspects of Home Hospitalization, mention should on one hand be made of its ability to open the hospital to the health community and population, and on the other its capacity to promote health team municipalization - the repercussions being improved possibilities for integral health care and the continuity of patient care. From this perspective, home care facilitates permeation of the physical barriers between the institutions and between levels, by allowing the adoption of new and more flexible organizational models, promoting the establishment of shared clinical-sanitary and organizational responsabilities, and in turn implicating the health and social professionals, patients, relatives, management and administration.