A physician house call program for the homebound.
BACKGROUND
A growing number of homebound frail older adults have multiple chronic diseases with frequent flare ups of acute episodes. A physician house call program affiliated with a nonprofit community health system was deployed as a strategy to improve quality of care for homebound patients.


METHODS
A medical team (either a physician and a medical assistant or a nurse practitioner), with a vehicle filled with portable medical equipment and supplies, fulfills the house call and primary care physician functions, establishes diagnoses, designs a treatment plan, arranges for any other needed services, and fosters continuity of medical care.


RESULTS
Interviews and focus groups with selected patients, family caregivers, program staff, and other service providers indicated that the program operated consistently with its intent. For example, the patient and caregiver interviews converged on four major themes: (1) the program improves patients' medication and health management and optimizes health, (2) caregivers felt more informed about the patients' medical conditions and medications and relieved of the burden of transporting patients to physicians, (3) the program reduces use of hospital and emergency services, and (4) the programs enables patients to die at home.


CONCLUSIONS
The success of any future programs and further replications will depend on creating trusting relationships with local service providers and getting decision makers of affiliated community health systems or hospitals to embrace the necessary vision.
Muramatsu
Naoko
N
School of Public Health, University of Illinois at Chicago, Chicago, USA. naoko@uic.edu
Mensah
Edward
E
Cornwell
Thomas
T
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017144:Focus Groups; D016330:Frail Elderly; D018577:Homebound Persons; D006792:House Calls; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D016730:Program Development; D015397:Program Evaluation; D011787:Quality of Health Care