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Ding-dong, it's the doctor calling! Home-based primary care may be a solution for homebound older adults

The Bottom Line

  • Older homebound adults with multiple health and social problems are particularly vulnerable and often do not get the medical care they need.
  • Receiving medical treatments at home may be a solution for those who can’t easily travel to clinics and doctors’ offices.
  • Home-based primary care programs help to improve the health of patients and contribute to a better quality of life for both patients and caregivers.

Do you remember when doctors made house calls? If not, you may remember your elders reminiscing about it, or you have a mental image – likely based on old movies – of a kindly gentleman making his way up the street, doctor-bag in hand. Today, house visits by doctors are not completely unheard of but they are a rarity, particularly in larger urban communities (1). For a host of reasons including time, money, transportation and safety concerns (2), “calling for the doctor” has been replaced with “going to the doctor.”


However, what about people who need medical care but struggle with the “going to” part? At any given time there are at least 100,000 permanently homebound adults in Canada, most of them elderly, frail and overwhelmed by multiple medical and social problems (3). Their circumstances make it difficult, if not impossible, to travel to doctors’ offices or clinics so they often don’t go – until there’s a crisis, at which point they tend to end up in the emergency department and/or are hospitalized (4).


This has led to the development of home-based primary care programs and there is keen interest in finding out whether they are a viable option for healthcare delivery to this vulnerable segment of the population


A high-quality systematic review of nine studies provides some insight. The studies assessed the impact of home-based primary care on outcomes such how often older adults went to the emergency department or were admitted to hospital or long-term care, as well as how many days they spent there. The studies also measured the effects on the patients and their caregivers (for example, their satisfaction with care and quality of life) and impact on healthcare costs (5). 


More than 46,000 participants – all housebound adults aged 65 or older – received home-based primary healthcare from an integrated team of medical professionals including general practitioners, geriatricians, nurse practitioners, physician assistants, social workers, physiotherapists, dietitians and dental hygienists. Approaches varied, but most included an initial in-home assessment and development of a care-plan, regular follow-up visits and/or phone calls, urgent care visits as needed and regular healthcare team meetings (5).


What the research tells us

There is strong evidence that home-based primary care helps to improve the health of patients. For example, after receiving regular medical care in their homes, older adults were admitted to hospital and long-term care facilities less often and/or spent fewer days in institutional care. Also they, and their family caregivers, reported a greater satisfaction with care, enjoyed a higher quality of life and played a more active role in making health and end-of-life decisions (5).


Home-based primary care might also be a promising option for older adults with chronic illnesses (6;7). One systematic review shows that home visits by healthcare providers can improve blood sugar, blood pressure, and quality of life for people with diabetes (6). Another found that this type of care might even better meet the needs of chronically ill older adults than hospital-based care. Older adults at the highest risk of hospitalization have the greatest potential to benefit from this service (7).


Key components of a successful home-based primary care program include: a thorough initial geriatric assessment of each patient; an integrated, inter-professional care team; regular care team meetings; and an after-hours telephone support line for emergencies (5). 


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Author Details

References

  1. Walkinshaw E. Back to black bag and horse-and-buggy medicine. CMAJ. 2011; 183(16):129-130.
  2. Eaton B. Why we do not make housecalls. Can Fam Physician. 2000; 46:1945-47.
  3. Stall N, Nowaczynski M, Sinha S. Back to the future: Home-based primary care for older homebound Canadians Part 1: Where we are now. Can Fam Physician. 2013; 59:2237-240.
  4. Wajnberg A, Wang K, Aniff M, et al. Hospitalizations and skilled nursing facility admissions before and after the implementation of a home-based primary care program. J Am Geriatr Soc. 2010; 58:1144-1147.
  5. Stall, N, Nowaczynski M, Sinha S. Systematic review of outcomes from home-based primary care programs for homebound older adults. JAGS. 2014; 62(12):2243-51. 
  6. Han L, Ma Y, Wei S, et al. Are home visits an effective method for diabetes management? A quantitative systematic review and meta-analysis. J Diabetes Investig. 2017; 8(5):701-708. doi: 10.1111/jdi.12630.  
  7. Totten AM, White-Chu EF, Wasson N, et al. Home-based primary care interventions. Comparative effectiveness review no. 164. AHRQ Comparative Effectiveness Reviews. 2016; 15(16)-EHC036-EF. 
 

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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