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Original article

Vol. 151 No. 0506 (2021)

Swiss family physicians and home visits: a 10-year retrospective analysis and typology based on billing data

DOI
https://doi.org/10.4414/smw.2021.20396
Cite this as:
Swiss Med Wkly. 2021;151:w20396
Published
06.02.2021

Summary

INTRODUCTION

In the context of an aging population, homecare visits by family physicians may contribute to maintaining older patients at home; however, home visits by family physicians have decreased in number in the last decade with the emergence of homecare-oriented healthcare services. We aimed to describe the diversity of activities and evolution over time of home visits by Swiss family physicians.

METHODS

This was a retrospective observational descriptive study. We used billing data collected by the cantonal trust centre for home visits made by family physicians of the canton of Vaud, Switzerland from 2006 to 2015. We separated billed items into specific categories, including the Tarmed catalogue (Swiss pricing system for medical services), laboratory catalogue, medications, medical material and vaccines. We compared billing patterns between emergency and routine visits. We used discrete mixture models to identify cluster classes of visits, and compare their characteristics.

RESULTS

From 2006 to 2015, Vaud family physicians made 451,634 home visits for which they billed a median of 5 items per visit (range 2–95). Most home visits (65%, 293,713) were routine visits consisting of consultation time without additional investigation. We identified four cluster classes of visits comprising routine visits, routine visits with laboratory tests, emergency visits during the day and emergency visits during the night. Routine visits were the main cluster class while emergency home visits were rare.

CONCLUSIONS

Family physician home visits are mainly routine visits without additional investigation. Thus, we wonder if a part of this activity could be delegated to other healthcare professionals.

References

  1. World Health Organization. Factsheet: Ageing and health. 2018. Available from: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
  2. Kohli R, Babel J, Deplazes J. Les scénarios de l'évolution de la population de la Suisse et des cantons, de 2020 à 2050. Neuchâtel: Swiss Federal Statistical Office. 2020.
  3. Kao H, Conant R, Soriano T, McCormick W. The past, present, and future of house calls. Clin Geriatr Med. 2009;25(1):19–34, v. doi:.https://doi.org/10.1016/j.cger.2008.10.005
  4. Meyer GS, Gibbons RV. House calls to the elderly--a vanishing practice among physicians. N Engl J Med. 1997;337(25):1815–20. doi:.https://doi.org/10.1056/NEJM199712183372507
  5. Mueller Y, David S, Cohidon C, Locatelli I, Senn N. Home visits made by general practitioners in the canton of Vaud between 2006 and 2015. Swiss Med Wkly. 2019;149:w20037. doi:.https://doi.org/10.4414/smw.2019.20037
  6. Association Vaudoise d’Aide et de Soins à Domicile. Dates-clés. 2012. Available from: http://www.avasad.ch/jcms/m_7022/fr/dates-cles
  7. Efstathopoulou A, David S, Herzig L. [Home visits by GPs - Considerations in Europe and in Switzerland]. Rev Med Suisse. 2016;12(537):1874–8. Article in French.
  8. Stuck AE, Egger M, Hammer A, Minder CE, Beck JC. Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis. JAMA. 2002;287(8):1022–8. doi:.https://doi.org/10.1001/jama.287.8.1022
  9. Elkan R, Kendrick D, Dewey M, Hewitt M, Robinson J, Blair M, et al. Effectiveness of home based support for older people: systematic review and meta-analysis. BMJ. 2001;323(7315):719–25. doi:.https://doi.org/10.1136/bmj.323.7315.719
  10. Liimatta H, Lampela P, Laitinen-Parkkonen P, Pitkala KH. Effects of preventive home visits on health-related quality-of-life and mortality in home-dwelling older adults. Scand J Prim Health Care. 2019;37(1):90–7. doi:.https://doi.org/10.1080/02813432.2019.1569372
  11. Mayo-Wilson E, Grant S, Burton J, Parsons A, Underhill K, Montgomery P. Preventive home visits for mortality, morbidity, and institutionalization in older adults: a systematic review and meta-analysis. PLoS One. 2014;9(3):e89257. doi:.https://doi.org/10.1371/journal.pone.0089257
  12. Aylin P, Majeed FA, Cook DG. Home visiting by general practitioners in England and Wales. BMJ. 1996;313(7051):207–10. doi:.https://doi.org/10.1136/bmj.313.7051.207
  13. Reuben DB, Fried TR, Wachtel TJ, Tinetti ME. When the patient cannot come to the doctor: a medical housecalls program. J Am Geriatr Soc. 1998;46(2):226–31. doi:.https://doi.org/10.1111/j.1532-5415.1998.tb02544.x
  14. Peterson LE, Landers SH, Bazemore A. Trends in physician house calls to Medicare beneficiaries. J Am Board Fam Med. 2012;25(6):862–8. doi:.https://doi.org/10.3122/jabfm.2012.06.120046
  15. Orup Larsen AS, Kristensen T, Lykkegaard J, Waldorff FB. Use of preventive home visits by general practitioners in patients diagnosed with dementia. Dan Med J. 2018;65(12):A5518.
  16. Statistique Vaud. Bilan démographique, grands groupes d'âges et population étrangère, par commune, Vaud, 2010–2018. 2019. Available from: http://www.scris.vd.ch/Default.aspx?DomId=1710
  17. TARMED. Navigateur tarifaire et banque de données. Bern: FMH Swiss Medical Association; 2019.
  18. Publique OFdlS. Liste des analyses (LA). 2019.
  19. DoXmart. Arzneimittel-Informationen und Tipps für Sie und Ihre Praxis. DoXmedical. 2008;1:19–27.
  20. SUVA. 2019.
  21. Everitt BS. An introduction to finite mixture distributions. Stat Methods Med Res. 1996;5(2):107–27. doi:.https://doi.org/10.1177/096228029600500202
  22. Govaert G, Nadif M. An EM algorithm for the block mixture model. IEEE Trans Pattern Anal Mach Intell. 2005;27(4):643–7. doi:.https://doi.org/10.1109/TPAMI.2005.69
  23. Carreira-Perpinan MA, Renals S. Practical identifiability of finite mixtures of multivariate bernoulli distributions. Neural Comput. 2000;12(1):141–52. doi:.https://doi.org/10.1162/089976600300015925
  24. KJ. B. RandomLCA: An R package for Latent Class with Random Effects Analysis. J Stat Softw. 2017;81(13):1–25.
  25. Grün B. Model-based clustering, in Handbook of Mixture Analysis. GC Sylvia Fruhwirth-Schnatter, Christian P Robert Editors. Chapman & Hall / CRC Press. 2019.
  26. Locatelli I, Monod S, Cornuz J, Büla CJ, Senn N. A prospective study assessing agreement and reliability of a geriatric evaluation. BMC Geriatr. 2017;17(1):153. doi:.https://doi.org/10.1186/s12877-017-0546-9
  27. Charrad M, Ghazzali N, Boiteau V, Niknafs A. NbClust: An R package for determining the relevant number of clusters in a data set. J Stat Softw. 2014;61(6):1–36. doi:.https://doi.org/10.18637/jss.v061.i06
  28. Santé et soins: chiffres-clés. In: Publique, SdlS, Editor. 2018.
  29. Clémence Merçay O. Le recours aux services d'urgence en Suisse - Description des différences cantonales. Obsan dossier 64. Neuchâtel: Obsan; 2018.
  30. Sanchez B, Hirzel AH, Bingisser R, Ciurea A, Exadaktylos A, Lehmann B, et al. State of Emergency Medicine in Switzerland: a national profile of emergency departments in 2006. Int J Emerg Med. 2013;6(1):23. doi:.https://doi.org/10.1186/1865-1380-6-23
  31. Corscadden L, Levesque JF, Lewis V, Strumpf E, Breton M, Russell G. Factors associated with multiple barriers to access to primary care: an international analysis. Int J Equity Health. 2018;17(1):28. doi:.https://doi.org/10.1186/s12939-018-0740-1
  32. van den Berg N, Meinke C, Matzke M, Heymann R, Flessa S, Hoffmann W. Delegation of GP-home visits to qualified practice assistants: assessment of economic effects in an ambulatory healthcare centre. BMC Health Serv Res. 2010;10(1):155. doi:.https://doi.org/10.1186/1472-6963-10-155
  33. Herzig L, Chappuis A, Camain JY, Burnand B, Jotterand S. [Adaptation of clinical practice guidelines--the example of cantonal Diabetes Program]. Rev Med Suisse. 2012;8(341):1049–53.
  34. Aebischer O, Rochat M, Méan M. [Use of clinical practice guidelines in medicine : what’s new? ]. Rev Med Suisse. 2017;13(584):2036–9.
  35. Favale R, Al-Sultan S, Gavinio R. [From permanence to the group practice and then to the health center: New frameworks for new roles and skills of the primary care physician]. Rev Med Suisse. 2018;14(620):1695–7.

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