The primary care and other health system use of home care patients: a retrospective cohort analysis

Abstract

Background: Robust and integrated primary care and home care are core components of effective chronic disease management in the community. We described the primary care and other health system use by a cohort of home care patients. Methods: We conducted a population-based retrospective cohort study of patients who received publicly funded home care in Ontario, Canada, from October 2014 to September 2016. Primary outcomes were primary care physician visits including coordination with home care, home visits and visits after hours or on weekends or holidays within 6 months of a home care assessment. Secondary outcomes included specialist physician visits, emergency department use, home care visits and placement in a long-term care home. Multivariable models examined associations between patient characteristics and subsequent primary care use. Results: There were 226 054 home care patients in our cohort, with a median age of 81 years. Following assessment, home care patients visited primary care physicians at a rate of 0.78 visits per month. Physician-based home care coordination codes were billed for 3.9% of patients. Primary care home visits were received by 13.1% of patients, and 15.1% of patients used primary care after hours or on weekends or holidays. Interpretation: Patients receiving publicly funded home care frequently visited a primary care physician. Physician billings for coordination between primary care and home care were infrequent but were more common in interprofessional primary care practices. Phys ician home visits were more likely to be received by the oldest and most functionally impaired patients, suggesting that home visits are responsive to the needs of home care patients.

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

“…We restricted our cohort to only those patients with an Activities of Daily Living (ADLs) Hierarchy Scale of 3 or higher, which indicates that extensive assistance is required in at least one of the activities of locomotion, personal hygiene, toilet use, and eating (n = 50,505) 32 . We focused on home care patients with this level of ADL impairment as they would likely have the most difficulty reaching office‐based primary care and prior work has indicated that these individuals are considerably more likely to receive a primary care home visit than home care patients with less or no functional impairment 27 …”

Associations between continuity of primary and specialty physician care and use of hospital-based care among community-dwelling older adults with complex care needs

“…Home care patients in Ontario are typically community-dwelling older adults characterized by multiple chronic conditions and/or functional and cognitive impairments. We focused on home care patients as the availability of accurate clinical measures, significant use of primary and specialist physicians, and frequent emergency department visitation make them an ideal population in which to examine the simultaneous influence of continuity of primary and specialty physician care [32]. We used multiple, linked, health administrative databases to identify a cohort of older adult home care patients who received a comprehensive home care assessment.…”

Effect of Access to After-Hours Primary Care on the Association Between Home Nursing Visits and Same-Day Emergency Department Use

“…We repeated the analyses including additional potential effect modifiers that may be correlated with access to after-hours care. These other modifiers were chosen based on previous research 8 and included primary care practice type, rurality, activities of daily living, hierarchy score (a measure of function impairment), 16 and presence of a live-in caregiver. We reported the odds ratio and 95% CIs of the association between home nursing and emergency department visits within each category of access to after-hours care, fixing the other effect modifiers at their mode (most frequent) value for categorical variables and mean value for continuous variables.…”

“…5,6 Older adults receiving home care services are a growing, frail population with particularly high rates of emergency department use. 7,8 Previous research has found that home nursing patients in Ontario, Canada have an increased risk of visiting the emergency department after 5:00 pm on the same day they receive a home nursing visit. 9 This effect is presumed to be the result of the nurse identifying a health issue that they are unable to appropriately address during the visit and referring the patient for further care.…”