Moderate-quality evidence reports home-based primary care as a promising model of care delivery for patients with chronic conditions

Totten AM, White-Chu EF, Wasson N, et al.  Home-based primary care interventions. Comparative effectiveness review no. 164 Effective Health Care Program. 2016 February;15(16).

Review question

How do home-based primary-care interventions affect health outcomes, patient and caregiver experience, and utilization of services among adults with serious or disabling chronic conditions? Also, how do the effects differ across patient and organizational characteristics, and which individual components are effective?

Background

The current model of care (i.e., centred in office and hospital settings and involving a disjointed array of providers) is not best suited for the increasing number of patients who are chronically ill, frail or disabled.

There is a need for high-quality primary care that is comprehensive, provides person-focused care, addresses a variety of conditions, and coordinates or integrates care across different types of providers and settings.

Home-based primary-care interventions are a promising means of organizing and delivering care that may better address the needs, values and preferences of chronically ill, frail and physically or cognitively disabled patients who have difficulty accessing other models of care.

How the review was done

A detailed search of a number of electronic databases for studies published from January 1995 until May 2015 was conducted. Studies that focused on adults with chronic illnesses or disabilities, home-based primary care as an intervention, and a setting of patients’ homes in the United States or other developed countries, were included in the review.

A total of 4,406 studies were identified in searches, and 19 were included in the review after assessments for eligibility.

The authors did not acknowledge any funding sources for this review.

What the researchers found

The review found that home-based primary care reduces utilization of hospital services, and does not change mortality compared to usual care.

Moderate-quality evidence indicated that patients who were at highest risk of hospitalization had the greatest potential to benefit from home-based primary care.

The study was unable to identify specific program components that were associated with effectiveness; in most studies the specifics of interventions were not well defined.

Conclusion

The review found that home-based primary care reduces utilization of hospital services, had no differences in function and mortality, and individuals at highest risk of hospitalization had the greatest potential to benefit. More evidence is needed that focuses on the content and organizational context of home-based primary-care interventions, and that determines which specific sub-groups of patients benefit most.