Physician Home Visit Patterns and Hospital Use Among Older Adults with Functional Impairments

Abstract

BACKGROUND Home‐based primary care has been associated with reductions in hospital use among homebound older adults, but population‐based studies on the general home visit patterns of primary care physicians are lacking. OBJECTIVE We examined the association between the provision of home visits by primary care physicians and subsequent use of hospital‐based care among their older adult patients with extensive functional impairments. DESIGN Population‐based retrospective cohort study. SETTING The setting was Ontario, Canada, from October 2014 to September 2016. PARTICIPANTS Older adults (aged ≥65 years) with extensive functional impairments receiving publicly funded home care. MEASUREMENTS We measured the provision of home visits by a patientʼs most responsible primary care physician during the year before a comprehensive home care assessment. Physician home visit patterns were measured as the proportion of the total outpatient visits in a year that were home visits, categorized with quartiles. Multivariable, multilevel negative binomial regression models examined the associations between physician‐level home visit provision and patient emergency department visits and hospital admissions over the 6 months following the home care assessment. RESULTS There were 49,613 patients in the cohort who were linked to 8,096 unique primary care physicians. A total of 69.1% of physicians provided at least one home visit in a year, with the median proportion of home visits to total visits ranging from 0.057% to 3.19% across quartiles. Patients whose physicians were in the highest home visit provision quartile had lower rates of emergency department visits (incidence rate ratio [IRR] = 0.93; 95% confidence interval [CI] = 0.90–0.96) and hospital admissions (IRR = 0.89; 95% CI = 0.85–0.93) compared with patients whose physician did not do home visits. CONCLUSION Home care patients with extensive functional impairments whose physicians provided higher levels of home visits had fewer emergency department visits and hospital admissions. Expanding home visits by primary care physicians could reduce hospital use by older adults living with functional impairments in the community.

Factors associated with instrumental support in transitional care among older people with chronic disease: a cross-sectional study

“…Transitional care teams have many difficulties in addressing the need for home visits, including the lack of a supervision system and well-qualified caregivers [ 32 ]. Coordinating various departments to improve personnel training, supervision and charging systems is an effective way to promote the long-term development of home visits [ 33 ]. The needs for health lectures and online platforms were also unmet because of the existence of false information and digital gaps [ 34 , 35 ].…”

Characteristics Associated With Financial or Non-financial Barriers to Healthcare in a Universal Health Insurance System: A Longitudinal Analysis of Korea Health Panel Survey Data

“…A recent study on primary healthcare reforms in Canada found that having regular access to a doctor reduced the risk of unmet healthcare needs (26). Encouraging individuals to have a regular primary healthcare provider seems a good way to not only reduce the most prevalent non-financial barriers to healthcare (time and information barriers) through fostering telehealth services or healthcare providers' or social service providers' visits to patients (73,74), but also to lessen financial barriers through maintaining continuity, comprehensiveness, and coordination of care (75). If regular primary healthcare providers and social service providers combine to form a primary care provider network to cater to the healthcare needs of individuals in each area of a country, it would be possible for individuals to receive timely and adequate healthcare services when they need them.…”

Physician home visits in Ontario: a cross-sectional analysis of patient characteristics and postvisit use of health care services

“…Although rates of physician home visits are still declining in some regions, financial incentives have driven a resurgence in these visits in the United States. 17 – 19 Yet, to our knowledge, there have been no population-based studies of physician home visit provision in Canada aside from 2 studies in specific subgroups (palliative care 16 and home care 8 recipients). Financial incentives for physician home visits were introduced in 2005 and 2012 in Ontario, Canada’s most populous province.…”

“…omebound people face challenges accessing preventive, chronic and acute care, which leads to adverse health effects and an overreliance on emergency and hospital-based services. [1][2][3] Home-based primary care 4 can reduce the use of emergency department visits and hospital admissions for homebound older adults, [5][6][7][8] can provide essential information about patients' needs and home life, 9 and is perceived positively by patients, caregivers and providers. [10][11][12] For many homebound older adults, strengthening primary care at home has the twin benefits of shifting care out of hospitals and delaying the need for residential long-term care.…”