Home visits - central to primary care, tradition or an obligation? A qualitative study

Abstract

BackgroundHome visits are claimed to be a central element of primary care. However, the frequency with which home visits are made is declining both internationally and in Germany despite the increase in the number of chronically ill elderly patients. Given this, the question arises as to how to ensure sufficient primary health care for this vulnerable patient group. The aim of this study was to explore German general practitioners' (GPs) attitudes with regard to the feasibility, burden and outlook of continued home visits in German primary care.MethodsQualitative semi-structured interviews were carried out with 24 GPs from the city of Hannover, Germany, and its rural surroundings. Data was analysed using qualitative content analysis.ResultsThe GPs indicated that they frequently conduct home visits, but not all of them were convinced of their benefit. Most were not really motivated to undertake home visits but some felt obliged to. The basic conditions covering home visits were described as unsatisfactory, in particular with respect to reimbursement and time constraints. House calls for vulnerable, elderly people remained undisputed, whereas visits of a social nature were mostly deleted. Urgent house calls were increasingly delegated to the emergency services. Visits to nursing homes were portrayed as being emotionally distressing. GPs considered good cooperation with nursing staff the key factor to ensure a successful nursing home visit. The GPs wanted to ease their work load while still ensuring quality home care but were unable to suggest how this might be achieved. Better financial compensation was proposed most often. The involvement of specially trained nurses was considered possible, but viewed with resentment.ConclusionsHome visits are still an integral aspect of primary care in Germany and impose a considerable workload on many practices. Though the existing situation was generally perceived as unsatisfactory, German GPs could not envisage alternatives if asked to consider whether the current arrangements were sustainable in the future. To guarantee an unaltered quality of primary home care, German GPs and health care policy makers should actively initiate a debate on the need for and nature of home visits in the future.

Home visits for frail older people: a qualitative study on the needs and preferences of frail older people and their informal caregivers

“…They also described home visits as unsatisfactory, in particular with respect to reimbursement and time constraints. 6 In the last few years there has been increasing interest in home visits, especially for frail older patients. This is mainly because the needs of frail older people are not well met by the current office-based, primary care model.…”

“…In western countries including the Netherlands, the number of home visits by GPs has decreased. [4][5][6] Theile et al conducted semi-structured interviews with 24 German GPs to explore their attitudes with regard to home visits. The GPs mentioned that visits of a social nature had mostly been discontinued.…”

Physicians’ attitudes toward home healthcare services in Turkey: A qualitative study

“…Literature shows that there is a wide range of reasons for individual home care visits (10,11,17,23,25). We did not detail the reasons for individual visits in this study, but explored physician's opinions on overall reasons for HCS itself.…”

“…The research participants were interviewed using semistructured questions. The interview guideline was prepared based on a similar study in the literature, with modifications relevant to the context; it was piloted with three physicians and restructured (Box 1) (17). There was no time constraint.…”

“…To the best of our knowledge, however, no qualitative studies have examined the experience of HCS delivery in Turkey. Our literature search revealed some quantitative (10)(11)(12)(13)(14)(15)(16) and qualitative studies (17)(18)(19)(20)(21)(22) dealing with different aspects of HCS. Several quantitative studies from Turkey are also available (23)(24)(25)(26).…”