Abstract
BACKGROUND: There is an increasing imperative for hospital services delivered in the home due to overburdened hospital systems, ageing populations and rising prevalence of chronic disease. Hospital in the home services have numerous advantages including reduced mortality, reduced hospital readmission and emergency department presentations and improved patient quality of life. Despite anticipated benefits for rural communities, which typically experience high prevalence of chronic disease and high rates of potentially avoidable hospitalisation, there appears to be limited research that focusses specifically on the provision of hospital in the home care in rural areas. METHODS: The aim of this scoping review was to identify facilitators and barriers to the provision of hospital in the home services in rural areas. A scoping review of literature published in English between 1990 and 2023 was conducted using Medline and EMBASE. A key term search strategy was employed using 'hospital in the home' and 'rural' plus equivalent search terms. Inclusion criteria primarily focused on articles that described acute, in-patient bed substitution for adult patients. RESULTS: Thirty-five articles met the inclusion criteria. These articles were diverse in terms of methodology, models of care, patient populations and country of origin. Many facilitators and barriers to the provision of hospital in the home were not necessarily specific to rural contexts, for example, workflows and patient selection. Rural specific facilitators included rurally tailored models of care, and rural community strengths such as resourcefulness, social capital and reciprocity. Conversely, rural specific barriers included travel distances and associated costs, complicated by challenging weather conditions or terrain. CONCLUSION: Whilst the evidence base for provision of hospital in the home care in rural areas was limited, consideration of the facilitators and barriers identified in this review should assist with the provision of hospital in the home services in rural areas.