MODELS OF GERIATRICS PRACTICE: When the Patient Cannot Come to the Doctor: A Medical Housecalls Program

Abstract

OBJECTIVES: To describe a medical housecalls program and to assess its ability to meet the medical needs of homebound patients. PROGRAM STRUCTURE: The housecalls program is part of a larger ambulatory practice situated in a senior center staffed by geriatricians and nurse practitioners. The practice serves as the major teaching site of outpatient geriatrics for a medical residency program. Scheduled visits are made every 3 to 4 months, and unscheduled visits are made weekday days for acute problems. PARTICIPANTS: Patients are eligible for the housecalls program if they live within a 15‐ minute drive of the center and are unable to leave their home. PROGRAM EVALUATION: The majority of the 71 patients in the housecalls program between 1993 and 1995 were female (81%), aged 85 years or older (52%), and dependent in one or more activities of daily living: 65% were dependent in bathing and 42% in dressing. A substantial minority (16%) had severe cognitive impairment. Patients received a mean of 5.0 visits per patient‐year. The majority of patients (59%) were treated at home for an acute illness or symptom ranging from upper respiratory tract infections to pneumonia and congestive heart failure. Approximately one‐quarter of the patients or their proxies elected to avoid hospitalization; several of these patients had complex illnesses managed in their homes. CONCLUSIONS: A wide range of medical problems can be addressed in patients' homes. Because our patients could not leave their homes easily, or at all, it is probable they would not have received routine medical care and would have used the emergency room for evaluation of acute problems if the housecalls program were not available. Despite their potential value in the care of frail older patients, housecalls will likely not become a widespread practice until barriers to their performance cited by physicians are addressed.

Swiss family physicians and home visits: a 10-year retrospective analysis and typology based on billing data

“…Several studies have evaluated trends and impact of home visits made by family physicians [12][13][14], but there are no studies describing the actual type of activities carried out during the visits [15]. A better understanding of home visit content may shed light on the specific contribution of family physicians in this action and may help in anticipating future needs and designing adapted services.…”

Home visits made by general practitioners in the canton of Vaud between 2006 and 2015

“…By home visits we mean visits to a patient's home by professional personnel for the purpose of diagnosis and/or treatment. Reasons to undertake home visits are diverse, and include routine followup, emergency visits [7], palliative care [8,9] and post-discharge follow-up [10] for patients that are usually unable to travel to the GP practice. GP home visits are highly valued by patients [4], and among the measures that contribute to maintaining elderly patients at home [11].…”

Home‐Based Primary Care: A Needed Primary‐Care Model for Vulnerable Populations

“…One notable exception is the Visiting Doctors Program at Mount Sinai School of Medicine, which has served thousands of patients in New York City, educated hundreds of students and residents, and contributed millions of dollars to the sponsor hospital's financial margin9,10 after it was founded in 1995 with significant hospital subsidization. Smaller teaching programs have shown improvements in advance care planning19 and have suggested decreases in acute‐care utilization 20…”