Home visits in rural general practice: what does the future hold?

Early Abstract:

Introduction: Declining house-call rates have been documented worldwide, however up-to-date data on current rates are lacking, particularly in rural settings. Systematic reviews in this area are inconsistent, however other work, principally qualitative research, demonstrates benefits for both doctors and patients. The aim of this study is to establish the current rate of, and reasons for, home visits in a rural general practice setting.
Methods: This was a descriptive observational study in the north-west of Ireland. Fourteen GP training practices with approximately 30,000 patients were recruited. Data on house-calls done in each practice was collected during May and June 2019. Anonymised data was analysed using Microsoft Excel and Graphpad.
Results: Data was received on 547 house-calls. The rate of house-calls done within normal working hours (443) was calculated at 87 house-calls/1000 patients/year (raw proportion 1.44%). Using the N-1 Chi-Squared test, this rate was compared to that calculated in a similar 2009 study (143/1000/year, raw proportion 2.43%), giving a difference of 0.991% (95% CI 0.759-1.22%, p < 0.001). This is a statistically significant reduction of 40% over 10 years. Most (86.2%) house-calls were to patients over 65 years old. House-calls were commonly  done for respiratory infection (17%), other infections (12%), palliative care (11%) and pain (11%). Most patients were managed solely within the community (88.3%), with 45.8% of those requiring a prescription, and only  11.7% of housecalls being referred to hospital.
Conclusion: There are documented benefits to home visits and yet the rate of house calls has been declining worldwide. With no recent literature on the rate or reasons for home visits in rural general practice this research has demonstrated that the house call rate in the north west of Ireland is falling, mirroring the decline seen in other parts of Europe, Australia and the USA. These house calls are mainly for elderly patients to address infection or palliative care and the majority can be managed successfully by the GP in the community. With an aging population with increasing multi-morbidity, planning for care delivery to these patients is important for clinicians going forward. We now need to decide if they are a service worth saving.