Gaining information about home visits in primary care: methodological issues from a feasibility study

Abstract

BackgroundHome visits are part of general practice work in Germany. Within the context of an expanding elderly population and a decreasing number of general practitioner (GPs), open questions regarding the organisation and adequacy of GPs’ care in immobile patients remain. To answer these questions, we will conduct a representative primary data collection concerning contents and organisation of GPs’ home visits in 2014. Because this study will require considerable efforts for documentation and thus substantial involvement by participating GPs, we conducted a pilot study to see whether such a study design was feasible.MethodsWe used a mixed methods design with two study arms in a sample of teaching GPs of the University Halle. The quantitative arm evaluates participating GPs and documentation of home visits. The qualitative arm focuses on reasons for non-participation for GPs who declined to take part in the pilot study.ResultsOur study confirms previously observed reasons for non-response of GPs in the particular setting of home visits including lack of time and/or interest. In contrast to previous findings, monetary incentives were not crucial for GPs participation. Several factors influenced the documentation rate of home visits and resulted in a discrepancy between the numbers of home visits documented versus those actually conducted. The most frequently reported problem was related to obtaining patient consent, especially when patients were unable to provide informed consent due to cognitive deficits.ConclusionsThe results of our feasibility study provide evidence for improvement of the study design and study instruments to effectively conduct a documentation-intensive study of GPs doing home visits. Improvement of instructions and questionnaire regarding time variables and assessment of the need for home visits will be carried out to increase the reliability of future data. One particularly important methodological issue yet to be resolved is how to increase the representativeness of home visit care by including the homebound patient population that is unable to provide informed consent.

Delegation von Hausbesuchen und Qualifikation nicht-ärztlicher Mitarbeiter in sächsischen Hausarztpraxen – Ergebnisse der Querschnittstudie SESAM-5

“…Die Methodik der SESAM-5 wurde in einer vorangehenden Feasibilitystudie getestet [19] und ist im publizierten Studienprotokoll bereits ausführlich beschrieben [20]. Alle bei der Kassenärztlichen Vereinigung Sachsen registrierten Hausärzte wurden im März 2014 angeschrieben (n = 2677).…”

Home visits in primary care: contents and organisation in daily practice. Study protocol of a cross-sectional study

“…Study design, recruitment strategies and instruments were tested and improved on by a previous feasibility study. 18 …”

“…Furthermore, documentation of a week was well accepted by participating general practitioners in our previous feasibility study. 18 Study period of 12 months was chosen to avoid seasonal biases regarding reasons for encounter.…”

“…Each home visit in the period of 1 week has to be documented by using a two-side semistructured questionnaire that was tested in the previous feasibility study. 18 The questionnaire includes closed and open questions regarding organisational features and content of the home visit as well as characteristics of the patient (see table 1 ). All participating FPs are invited to complete a supplementary questionnaire.…”

“…Our previous feasibility study showed low missing rates (<5%) regarding majority of the questions. 18 In case of missing data >10% we will conduct missing data analysis to examine causes of missing data. Depending on number of missing data and structure of the items we will decide on pairwise deletion or data imputation considering uncertainty of associations between variables as well as reliability of data analysis.…”