Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 151 No. 3940 (2021)

Frequency of home visits where general practitioners are exposed to a problem different from that foreseen – a Swiss cross-sectional study

  • Nina Meuli
  • Katharina Tabea Jungo
  • Christoph Merlo
  • Sven Streit
  • Stefan Essig
DOI
https://doi.org/10.4414/SMW.2021.w30062
Cite this as:
Swiss Med Wkly. 2021;151:w30062
Published
06.10.2021

Summary

BACKGROUND: When a home visit is considered, patients’ suspected health problems are important for correct triage, the decision  for or against the visit and allocation of the visit to a general practitioner (GP) or a nurse practitioner. Misjudgment might lead to suboptimal patient outcomes.

OBJECTIVE: We aimed to evaluate the accuracy of suspected health problems (based on pre-visit assessments) by comparing them with the actual health problems (post-visit assessments) and investigating associated factors.

METHODS: GPs of the Swiss Sentinel Surveillance Network (Sentinella) reported pre-visit and post-visit assessments and patient characteristics for up to 20 consecutive home visits, which they conducted in 2019. Using multivariable logistic regressions, we investigated associations between patient and clinical factors and unconfirmed suspected health problems from pre-visit assessments and unforeseen actual health problems from post-visit assessments.

RESULTS: Overall, 114 GP practices participated. The GPs reported 1496 patient visits with a total of 1789 and 1762 health problems from pre-visit and post-visit assessments, respectively, that were included in the analysis. Musculoskeletal and circulatory problems were the most common in patients receiving home visits. The health problems from pre-visit and post-visit assessments were unconfirmed and unforeseen in15% and 13% of the cases, respectively. Older age (odds ratio [OR] 1.1 in 10-year steps; 95% confidence interval [95% CI] 1.0–1.3) and urgent visits (OR 1.7 compared with regular visits; 95% CI 1.1–2.6) showed a trend for more unforeseen health problems.

CONCLUSION: When home visits were conducted, about one out of seven health problems from pre-visit and post-visit assessments were unconfirmed and unforeseen. Particularly when patients were older or visits were urgent, there were higher odds of unconfirmed and unforeseen health problems.These results should be considered when triaging patients.

References

  1. 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 Mar;149(11-12):w20037. https://doi.org/10.4414/smw.2019.20037
  2. van den Berg MJ, Cardol M, Bongers FJ, de Bakker DH. Changing patterns of home visiting in general practice: an analysis of electronic medical records. BMC Fam Pract. 2006 Oct;7(1):58. https://doi.org/10.1186/1471-2296-7-58
  3. Kaneko M, Van Boven K, Takayanagi H, Kusaba T, Yamada T, Matsushima M. Multicentre descriptive cross-sectional study of Japanese home visit patients: reasons for encounter, health problems and multimorbidity. Fam Pract. 2020 Mar;37(2):227–33. https://doi.org/10.1093/fampra/cmz056
  4. Theile G, Kruschinski C, Buck M, Müller CA, Hummers-Pradier E. Home visits - central to primary care, tradition or an obligation? A qualitative study. BMC Fam Pract. 2011 Apr;12(April):24. https://doi.org/10.1186/1471-2296-12-24
  5. Pochert M, Voigt K, Bortz M, Sattler A, Schübel J, Bergmann A. The workload for home visits by German family practitioners: an analysis of regional variation in a cross-sectional study. BMC Fam Pract. 2019 Jan;20(1):3. https://doi.org/10.1186/s12875-018-0891-6
  6. Joyce C, Piterman L. Trends in GP home visits. Aust Fam Physician. 2008 Dec;37(12):1039–42. Available from: https://www.racgp.org.au/afpbackissues/2008/200812/200812joyce.pdf
  7. Norful AA, de Jacq K, Carlino R, Poghosyan L. Nurse practitioner–physician comanagement: A theoretical model to alleviate primary care strain. Ann Fam Med. 2018 May;16(3):250–6. https://doi.org/10.1370/afm.2230
  8. Gysin S, Sottas B, Odermatt M, Essig S. Advanced practice nurses’ and general practitioners’ first experiences with introducing the advanced practice nurse role to Swiss primary care: a qualitative study. BMC Fam Pract. 2019 Nov;20(1):163. https://doi.org/10.1186/s12875-019-1055-z
  9. Mellor RM, Sheppard JP, Bates E, Bouliotis G, Jones J, Singh S, et al. Receptionist rECognition and rEferral of Patients with Stroke (RECEPTS): unannounced simulated patient telephone call study in primary care. Br J Gen Pract. 2015 Jul;65(636):e421–7. https://doi.org/10.3399/bjgp15X685621
  10. Maier CB, Barnes H, Aiken LH, Busse R. Descriptive, cross-country analysis of the nurse practitioner workforce in six countries: size, growth, physician substitution potential. BMJ Open. 2016 Sep;6(9):e011901. https://doi.org/10.1136/bmjopen-2016-011901
  11. Ramadanov N, Klein R, Aguilar Valdez AD, Behringer W. Influence of patient-specific factors on the diagnosis by the prehospital emergency physician. Notf Rettmed. 2020;23(4):282–8. https://doi.org/10.1007/s10049-019-00633-2
  12. Heuer JF, Gruschka D, Crozier TA, Bleckmann A, Plock E, Moerer O, et al. Accuracy of prehospital diagnoses by emergency physicians: comparison with discharge diagnosis. Eur J Emerg Med. 2012 Oct;19(5):292–6. https://doi.org/10.1097/MEJ.0b013e32834ce104
  13. Eames J, Eisenman A, Schuster RJ. Disagreement between emergency department admission diagnosis and hospital discharge diagnosis: mortality and morbidity. Diagnosis (Berl). 2016 Mar;3(1):23–30. https://doi.org/10.1515/dx-2015-0028
  14. Sentinella Meldesystem. http://sentinella.ch/de/info. Accessed December 1, 2020.
  15. Excoffier S, Herzig L, N’Goran AA, Déruaz-Luyet A, Haller DM. Prevalence of multimorbidity in general practice: a cross-sectional study within the Swiss Sentinel Surveillance System (Sentinella). BMJ Open. 2018 Mar;8(3):e019616. https://doi.org/10.1136/bmjopen-2017-019616
  16. WONCA International Classification Committee. International Classification of Primary Care ICPC-2-R, Revised second edition. Oxford Univ Press 2005.
  17. Voigt K, Liebnitzky J, Riemenschneider H, et al. Beratungsanlässe bei allgemeinärztlichen hausbesuchen: erste ergebnisse der SESAM-3-studie. Z Allgemeinmed. 2011;87(2):65–71. https://doi.org/10.3238/zfa.2011.065
  18. Tandjung R, Hanhart A, Bärtschi F, Keller R, Steinhauer A, Rosemann T, et al. Referral rates in Swiss primary care with a special emphasis on reasons for encounter. Swiss Med Wkly. 2015 Dec;145:w14244. https://doi.org/10.4414/smw.2015.14244
  19. N’Goran AA, Blaser J, Deruaz-Luyet A, Senn N, Frey P, Haller DM, et al. From chronic conditions to relevance in multimorbidity: a four-step study in family medicine. Fam Pract. 2016 Aug;33(4):439–44. https://doi.org/10.1093/fampra/cmw030
  20. Tarifsystem TA. https://www.bag.admin.ch/bag/de/home/versicherungen/krankenversicherung/krankenversicherung-leistungen-tarife/Aerztliche-Leistungen-in-der-Krankenversicherung/Tarifsystem-Tarmed.html. Accessed December 1, 2020.
  21. Sporer KA, Solares M, Durant EJ, Wang W, Wu AH, Rodriguez RM. Accuracy of the initial diagnosis among patients with an acutely altered mental status. Emerg Med J. 2013 Mar;30(3):243–6. https://doi.org/10.1136/emermed-2011-200452
  22. Al-Huthail YR. Accuracy of referring psychiatric diagnosis. Int J Health Sci (Qassim). 2008 Jan;2(1):35–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068718/pdf/ijhs-2-1-0035.pdf
  23. Nemec M, Koller MT, Nickel CH, Maile S, Winterhalder C, Karrer C, et al. Patients presenting to the emergency department with non-specific complaints: the Basel Non-specific Complaints (BANC) study. Acad Emerg Med. 2010 Mar;17(3):284–92. https://doi.org/10.1111/j.1553-2712.2009.00658.x
  24. Singh H, Schiff GD, Graber ML, Onakpoya I, Thompson MJ. The global burden of diagnostic errors in primary care. BMJ Qual Saf. 2017 Jun;26(6):484–94. https://doi.org/10.1136/bmjqs-2016-005401
  25. van der Biezen M, Schoonhoven L, Wijers N, van der Burgt R, Wensing M, Laurant M. Substitution of general practitioners by nurse practitioners in out-of-hours primary care: a quasi-experimental study. J Adv Nurs. 2016 Aug;72(8):1813–24. https://doi.org/10.1111/jan.12954
  26. Chmiel C, Huber CA, Rosemann T, Zoller M, Eichler K, Sidler P, et al. Walk-ins seeking treatment at an emergency department or general practitioner out-of-hours service: a cross-sectional comparison. BMC Health Serv Res. 2011 May;11(1):94. https://doi.org/10.1186/1472-6963-11-94
  27. Osakwe ZT, Aliyu S, Sosina OA, Poghosyan L. The outcomes of nurse practitioner (NP)-Provided home visits: A systematic review. Geriatr Nurs. 2020 Nov - Dec;41(6):962–9. https://doi.org/10.1016/j.gerinurse.2020.07.001
  28. Gysin S, Bischofberger I, Meier R, van Vught A, Merlo C, Essig S. Nurse Practitioners in Swiss Family Practices as Potentially Autonomous Providers of Home Visits: An Exploratory Study of Two Cases. Home Heal Care Manag Pract. 2021. doi:https://doi.org/10.1177/1084822320946289

Most read articles by the same author(s)