Doctor in the house? Project may open door to better care
CMAJ 2000;162:1186
House calls provide ideal opportunities for physicians to learn about patients, says Dr. Irene Cohen. The London, Ont., family physician is medical coordinator of Integrated Physician Services in the Home (IPSITH), a pilot project to provide home-based treatment for acutely ill patients who would otherwise be in hospital. She says physicians often discover issues during house calls that might not be detected during office visits.
 | Dr. Irene Cohen with home care patient Alice Keukelaar |
Cohen recalls one patient who mixed her medications together in a fruit bowl because they were "pretty" and then used colour preferences when deciding which to take. On another occasion, Cohen visited a new elderly patient and found her living in her 1-bedroom apartment with only a bed, chair, tiny fridge and no food. The patient, who believed she was coping well since her husband's death a year earlier, was later diagnosed with Alzheimer's disease. Cohen says the patient likely would have presented herself well during an office visit, creating delays in diagnosis and obtaining services. She thinks issues surrounding hygiene, family dynamics, spousal support and health are more readily apparent through house calls. "It's a definite eye-opener," she says.
Under IPSITH, acutely ill patients are receiving between 5 and 15 days of in-home care from a multidisciplinary community team that includes a case manager, nurse practitioner, the patient's family physician and health professionals from provider agencies (CMAJ 1999;161[11]:1437). Since April 1999, 39 FPs and nearly 40 specialists have agreed to participate in the program, which is expected to serve between 100 and 150 patients during the 2-year pilot period.
Cohen says house calls are not a thing of the past. She says a survey of London family physicians indicated that 60% to 70% of them make house calls; most involve elderly or severely disabled patients, but palliative care is becoming a larger part of home care. She says highly skilled teams of palliative care nurses in London offer tremendous assistance to family physicians. "It's become a real collaboration between all the team players to give [dying] patients optimum care in their homes."
As more and more people with significant illnesses and disabilities remain at home, Cohen foresees house calls becoming "absolutely necessary. We have to be more open to this kind of care. I hope the government looks at it that way as well." — Lynne Swanson, London
 |
Send a letter to the editor Envoyez une lettre à la rédaction |
© 2000 Canadian Medical Association or its licensors
