Comparison of hospital versus home intravenous antibiotics in adults with cystic fibrosis
G.Esmond, City University, London

The concept of home intravenous antibiotic therapy for acute respiratory exacerbations is rapidly becoming popular, in response to economic pressures and patient choice.
Comparison of hospital and home intravenous antibiotic therapy in adults with cystic fibrosis for clinical outcomes and quality of life was studied using a quasi-experimental design. A pre and post test was used to measure clinical outcomes of Forced Expiratory Volume in one second (FEV1), Forced Vital Capacity (FVC), oxygen saturations (SaO2), Body Mass Index (BMI) and quality of life using the Cystic Fibrosis Quality of Life (CFQoL) questionnaire.
Thirty adult cystic fibrosis patients (15 hospital and 15 home) were recruited to the study once they had chosen where they undertook their treatment. There were 6 females and 9 males in the hospital group and 9 females and 6 males in the home group which was on average 4 years older. When the groups were compared for clinical outcomes the hospital group showed greater improvement in Forced Vital Capacity (p<0.01). There were no differences in quality of life when the hospital and home groups were compared (p>0.05), although changes achieved with treatment showed differences in five of the nine quality of life domains.
Lung function improved more in the hospital group, suggesting that acute respiratory exacerbations were not as effectively treated at home. Although there were no differences in quality of life between the home and hospital groups, the Cystic Fibrosis Quality of Life (CFQoL) questionnaire was able to detect transient changes in health status during the course of intravenous antibiotics.
If the patients right to choose where they receive treatment is to be supported, further research is required to determine the reasons for home care being less clinically effective in treating acute respiratory exacerbations in cystic fibrosis patients.

Traditional hospitalisation versus homecare: analysis of choice and its repercussions on the cystic fibrosis child's family. The case of the intravenous antibiotic treatment, from the maternal point of view
M. Kerbrat, CF Centre of Roscoff, France

The treatment of intravenous antibiotherapy, marking a dreaded stage in the evolution of the disease, can be carried out in traditional hospitalisation (TH) or in home  care (HC). The objective is identify psychological elements leading CF children's mothers to prefer TH or HC, then consequences of their choice. After having recalled the medical and psychological aspects of cystic fibrosis, a library search on the topic of the hospitalisation of the children makes it possible to pose some starting assumptions. The method used to verify them is based on semi-directing talks in the local setting (N=14), and on a questionnaire at the national level (N=115), targetted to mothers of children aged from two to fourteen years. The analysis by themes of the contents of the talks and the comparative statistic analysis of the results of the questionnaires make it possible to pose various results: the choice is strictly depending on the mother's age, on the paternal level of study, on the systematisation of the treatments, on the number of previous IAT, on the home's fitting out, on the information about the disease. The choice has consequences on the feelings of anguish and depression, on the friendly network, on the leisure activities, on the relations between mothers and siblings. Motivations are essentially based on practical considerations. They are depending on the child and his family's well-being, on better care, on a easier organization, on the desire of investment, on the representation of the disease. Conclusion: no psychological profile distinguishes mothers choosing the TH of those opting for the HC. The repercussions of IAT don't differ fundamentally according to the chosen modality. TH often appears as a period pre-HC. These types of study, as well as the intervention, on the field, of psychologists, are major keys to make a real advantage of the chosen modality for all the protagonists, especially in term of quality of life.