Attitudes, perceptions and practice patterns of primary care practitioners towards house calls

Abstract

INTRODUCTION Historically, doctors routinely delivered medical care to sick patients in their homes, with house calls accounting for 40% of all doctor–patient encounters in the 1940s. This proportion has dwindled to less than 1% today. Advantages of house calls include decreased mortality rates, admissions to long-term care in the general elderly population and increased patient appreciation. Therefore, we asked ‘Why do some primary care practitioners do house calls and what are the reasons that others do not?’. AIM This review aims to understand the attitudes, perceptions of Primary Care Practitioners (PCPs) towards house calls and their practice patterns. METHODS A search of PubMed and Embase was conducted for articles published before 31 December 2017. A total of 531 articles with 44 duplicates was generated. Of these, 13 were shortlisted along with three hand-searched articles for a total of 16 articles included in this review. RESULTS Primary care providers were aware of the role of house calls and their advantages in enabling comprehensive care for a patient. They saw making house calls as a responsibility with rewards that enhanced the doctor–patient relationship. However, opportunity cost, time, medical liability and miscellaneous reasons such as the lack of training precluded some PCPs from making more house calls. DISCUSSION Primary care practitioners recognise the importance of house calls, especially in the care of elderly patients, but there are many unaddressed issues such as opportunity cost and clinical inadequacy in the home setting that have caused a decline in house calls over the years.

The importance of supportive relationships with general practitioners, hospitals and pharmacists for mothers who ‘give medicines’ to children with severe and profound intellectual disabilities

“…The issue of house calls by GPs was raised within this study with a perceived unwillingness on the part of GPs to engage in this service despite the complexities of mothers attending the GP clinic with a child with severe and profound intellectual disabilities and associated medical needs. Historically, house calls made up 40% of all patient-doctor encounters in the 1940’s (Soh and Low, 2018) while today the proportion of GP consultations that are house calls has dwindled to less than 1% (Kao et al, 2009). While reasons for the fall are attributed to more access to transportation, time constraints and economic considerations, the benefits for children in this study would seem overwhelming with difficulty in transportation, equipment and risk of infection, real concerns for mothers.…”

From the Editor: Reading, writing and research impact

“…15 Soh and Low reviewed the literature on house calls by general practitioners and in doing so they have inadvertently set an agenda for research in this issue of increasing importance as populations age. 16 Why do we not know more about the epidemiology of house calls -who is visited, why and where? Is the call for house calls going to become more pressing?…”

Home sweet home: GPs’ response to an increase in the fee size for home visits

“…However, these visits are infrequently provided and in recent years many countries, including Denmark, have experienced a decline in the provision of home visits [9][10][11]. The timeconsuming nature of home visits, the poor remuneration associated with them, a large part-time workforce, and concerns about personal safety have been cited as possible reasons for the decline [12].…”