Medical Journal of Dr. D.Y. Patil Vidyapeeth

EDITORIAL COMMENTARY
Year
: 2019  |  Volume : 12  |  Issue : 2  |  Page : 101--102

Home visits and family physician


Vadisha Bhat 
 Department of Otorhinolaryngology, K S Hegde Medical Academy, Mangalore, Karnataka, India

Correspondence Address:
Vadisha Bhat
Department of Otorhinolaryngology, K S Hegde Medical Academy, Mangalore, Karnataka
India




How to cite this article:
Bhat V. Home visits and family physician.Med J DY Patil Vidyapeeth 2019;12:101-102


How to cite this URL:
Bhat V. Home visits and family physician. Med J DY Patil Vidyapeeth [serial online] 2019 [cited 2019 Nov 12 ];12:101-102
Available from: http://www.mjdrdypv.org/text.asp?2019/12/2/101/254769


Full Text



Home visits were routine for an Indian family physician in olden days. Attending a sick person at his residence was a common practice of a family physician, and the diagnosis was mainly based on the clinical knowledge of symptoms and signs of disease. This was more common in a rural setup, where due to the lack of transport facility, shifting a sick person to the doctor's clinic was not possible. The reason for home visit varies from a routine health checkup to a real emergency condition. With the increase in life expectancy of the population, there is an increase in the number of people seeking in-home care worldwide. In India, the population of elderly people is growing and likely to triple in another 10 years.

The practice of home visits is also common in the United States, Europe, and Canada. Until the 1940s, the majority of physicians in America and Britain used to conduct home visits, and hence, they spend a lot of time in traveling from one place to another.[1] In America, about 50% of primary care physicians conduct home visits, though many of them do only a few visits every year. Lack of reimbursement and the busy schedule in clinic-based practice and time spent in traveling are the factors cited for not attending house calls.[2]

Family physicians can provide most of the care to elderly, during a home visit. For conducting an effective home visit, a physician must acquire basic knowledge, attitude, and skill apart from having a portable set of basic equipment.[2] Home visits, apart from performing the clinical examination, also allow the physician to assess patients living condition and the family supports. Knight and Adelman defined the things to be assessed during a home visit, with a mnemonic INHOME, which includes Immobility, Nutrition, Housing, Other people, Medications, and Examination; later, this is further expanded as INHOMESS with the addition of Safety and Spiritual health.[3]

In the United States of America, in-home care has grown rapidly after 1978. One important factor for such growth is the health insurance by the Medicare prospective payment system, where the expenses are reimbursed if the home health care is planned by the doctor and the care is received from a Medicare-certified home health agency.[4]

If the home visits are not planned and organized wisely, this can adversely affect one's clinical practice.[2] In India, there are few start-ups which facilitate home visits of doctors for needy patients and provide a variety of health-care services such as primary care, chronic disease management, geriatric care, and postoperative care in the home setting.[5],[6] However, medical insurance companies need to be made aware of the importance of home care, especially by reducing the duration of the hospital stay, thereby the insurance cover may also be extended to home health care.

The teaching of home care is not given due importance in the medical education curriculum. Even though an old practice, home care fell into disuse, and restoring it is difficult. Community medicine gives an opportunity for home visits; however, emphasis is more on preventive medicine. Neale et al. developed a home visit rotation program for family medicine residents to provide a comprehensive understanding of home health care, with particular importance on geriatric, community, and rehabilitative medicine. Evaluation of the program suggested that at the end of the rotation posting, residents are more likely to agree that home visits are an essential part of residency training.[7]

Jakubovicz and Srivastava evaluated a training program for family practice residents by allocating a family to each resident and a longitudinal follow-up of 2 years, with a rationale of developing a sense of ownership and responsibility among residents for their assigned homebound patients. They concluded that residents' willingness to provide home visits did not increase over the course of the residency, but their confidence in making house calls did increase. There was also a trend toward increased confidence among residents in working with community agencies.[8] With a growing population of elderly and with the rising cost of institutional care, home services need to be considered as a core competency for family practice residents. Scientific publications about home visits and the training of residents about home visits are lacking in Indian literature. There is a need for research and publications to emphasize the importance of home visits and generate interest in the home health care among the residents.

The “black bag” of an olden day doctor may now contain a digital thermometer, pulse oximeter, and a digital sphygmomanometer, but the aim of the bag will remain the same.[1] Properly conducted home visits can enhance the patient–doctor relationship, apart from cost-effective delivery of health care.

References

1Herritt BJ. The house call: Past, present and future. Univ Toronto Med J 2012;89:175-7.
2Unwin BK, Jerant AF. The home visit. Am Fam Physician 1999;60:1481-8.
3Knight AL, Adelman AM. The family physician and home care. Am Fam Physician 1991;44:1733-7.
4Swan JH, Mahoney C, Hunter H. In-home physician visits and large medical groups. Home Health Care Serv Q 1991;12:19-32.
5Available from: https://www.homehealthcarenews.com/2018/01/why-indias-home-health-start-ups-are-raising-serious-funding. [Last accessed on 2018 Nov 21].
6Available from: https://www.timesofindia.indiatimes.com/business/india-business/Startups-bring-the-doctor-and-hospital -home/articleshow/36274016.cms. [Last accessed on 2018 Nov 21].
7Neale AV, Hodgkins BJ, Demers RY. The home visit in resident education: Program description and evaluation. Fam Med 1992;24:36-40.
8Jakubovicz D, Srivastava A. Home visits in family medicine residency: Evaluation of 8 years of a training program. Can Fam Physician 2015;61:e189-95.