Home visits on a downward trend - European forum for primary care

Home visits on a downward trend - European forum for primary care

Ulrike Junius-Walker
Institute of General Practice
Hannover Medical School
Home visits on a downward trend:
Implications for older people
Decline in home visits
Proportion of home visits in relation to consultations
NL (1): 1987 / 2001
(103 / 80 practices)
(125000 / 58000 reg. patients),
UK (2): 1995 / 2007
(102 /465 practices)
(859000 / 4 mill reg. patients)
Ger (3): 1997 / 2001
(15 practices)
(29.745 / 31.785 patients seen)
%
Noteworthy: Variation of „visit workload“
Home visits (per GP and week): NL 21 - 12
1993 and 2012
UK 19 - 6
Ger 34 - 14
Bel 44 - 23
Nor 6 - 1
(4)
Proportion of visited patients per 5 year-age-group (2002)
80 %
Older patients are affected by the decline
70
80% of home visits are for patients 65 years+ (3)
Visits/year for age groups 65-79 and 80+: av. 6 and 9
60
50
male
männl
female
weibl
40
30
GPs consider 80% of their visited patients as having
multimorbidity
GPs‘ reasons for home visits:
75% of patients no adequate transport
68% of patients too sick to visit practice
20
Type of visit: 42% routine (monitoring) visits,
58 % specific (acute) complaints
10
0
95
85
75
65
55
45
35
25
15
5
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100+ years
Reasons for the decline: visits are no favourites
•
•
•
•
•
•
(5)
poor GP recruitment with practices having no successors
visits are time consuming
visits are badly paid
visits are interfering with daily work schedule
more diagnostic uncertainty in home visits
visits to respite homes are depressing
(6)
EVA, VERAH and Co: The „German“ solution
1. Delegation to practice nurses
3 year training (accountant, receptionist, nurse) + 250 hours
2. Delegation to a visiting GP employed by the regional practices
Decline in overall (nursing) home visits:

What are the solutions in your country?
Decline in visits from different starting levels
in Europe:

What is an adequate provision?
Measuring adequate provision of home visits:

Does quantity matter?

How do we measure and define quality?
(1) van den Berg M, et al. Changing patterns of home visiting in general practice: an analysis of electronic medical records. BMC Fam Pract 2006;7:58.
(2) Q research. Trends in consultation rates in general practice 1995-2007. https://catalogue.ic.nhs.uk/publications/primary-care/general-practice/qres-rep-tren-cons-rate-geneprac-1995-08/qres-rep-cons-gene-prac-1995-08-95-07-rep.pdf .
(3) Snijder E, et al. Hausbesuche: Versorgungsforschung mit hausärztlichen Routinedaten von 158.000 Patienten. Gesundheitswes 2007;67:679-85.
(4) Data were collected in the context of the 1993 European Task Profile Study and the 2012 QUALICOPC study, both coordinated by NIVEL
(the Netherlands Institute for Health Services Research). With thank s to W. Boerma for kindly providing current data.
(5) Voigt K, et al. Beratungsanlässe bei allgemeinärztlichen Hausbesuchen. Erste Ergebnisse der SESAM 3 Studie. Z Allg Med 2011; 87:65-71.
(6) Theile G, et al. Home visits – central to primary care, tradition or an obligation? A qualitative study. BMC Fam Pract 2011;12:24.
MHH
Institut für Allgemeinmedizin, OE 5440
Carl-Neuberg-Straße 1, 30625 Hannover
[email protected]
www.mh-hannover.de