Health Care Technology at Home

Complex forms of clinical treatments administered at home have begun to emerge, such as intravenous therapy, artificial life support, assisted ventilation, cancer chemotherapy, and palliative care. This homeward shift of specialized care previously provided only in hospitals is leading to the creation of a new model of care, of which advanced technologies are a ubiquitous component. However, these changes are raising many organizational issues that one should better define before devising measures fostering the development of such services in Québec.

Since the assessment of this new intervention modality is necessarily context-based, it first describes the main problems attendant upon the evolution of home-based care in Canada. We first note the weak interface between community-based home care and hospital-based home care programs. In addition to leading to increased responsibility being delegated to patients and caregivers, the introduction of specialized equipment into the home setting poses a number of risks. Lastly, despite the lack of cost-effectiveness data on home care services, they continue to be implemented.

The report then examines the prevalence and patterns of home use of certain advanced technologies by Québec’s local community health centres (CLSCs) before the new local health and social services net- works were established, and highlights the potential obstacles to and the opportunities for expanding the range of specialized home care. To broaden the discussion, this is followed by a synopsis, based on a re- view of the international scientific literature, of the organizational, social, ethical and legal aspects of specialized home care. Lastly, we examine how these aspects could be taken into account when providing and evaluating home care services in the specific context of Québec health-care reform.

The assessment thus brings out four main messages, around which are formulated recommendations aimed at better coordination of specialized home services, increased patient and caregiver support, a more critical look at the medicalization of the home, and the need to perform cost-effectiveness studies of these services.