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Original article

Vol. 151 No. 2728 (2021)

Time trends in general practitioners’ home visits for older patients: a retrospective cross-sectional study from Switzerland

DOI
https://doi.org/10.4414/smw.2021.20539
Cite this as:
Swiss Med Wkly. 2021;151:w20539
Published
14.07.2021

Summary

WHAT IS KNOWN ON THE SUBJECT, AND WHAT THE STUDY ADDS: The number of home visits by general practitioners (GPs) has decreased in recent years, in contrast to the increasing number of frail and older patients in western countries. Current data on GP home visit numbers and rates are lacking for Switzerland. Our study provides new data on GP home visit numbers and rates, and their associations with patient characteristics.

AIM

Our study aimed at investigating the time trend of GP home visits to older patients from 2014 to 2018 in Switzerland, and associations between GP home visits and patient characteristics including healthcare utilisation and living situation.

METHODS

Retrospective cross-sectional study of insurance claims data from 2014 to 2018 among patients aged ≥65 years (Nextrapolated = 2,095,102; Nraw = 339,301). We compared patient characteristics between patients with and without GP home visits using descriptive statistics. We performed logistic regression analyses to detect associations between patient characteristics and GP home visits, including subgroups of patients aged ≥80 and patients living in a nursing home. Regression models were adjusted for age and sex.

RESULTS

The yearly GP home visit rate declined from 10.7% to 9.3% from 2014 to 2018 (p <0.0001). Among patients aged ≥80, the rate declined from 26.1% to 23.1% (p <0.0001), and among patients living in a nursing home from 68.7% to 65.8% (p <0.0001). Regression analyses revealed increased health care utilisation and a higher burden of morbidity and mortality in patients receiving GP home visits.

CONCLUSION

There is an ongoing decline of GP home visits over the past years, with a potentially negative impact on the quality of care for older and frail patients.

References

  1. 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;12(1):24. doi:.https://doi.org/10.1186/1471-2296-12-24
  2. van Kempen JA, Robben SH, Zuidema SU, Olde Rikkert MG, Melis RJ, Schers HJ. Home visits for frail older people: a qualitative study on the needs and preferences of frail older people and their informal caregivers. Br J Gen Pract. 2012;62(601):e554–60. doi:.https://doi.org/10.3399/bjgp12X653606
  3. 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;7(1):58. doi:.https://doi.org/10.1186/1471-2296-7-58
  4. 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
  5. Snijder EA, Kersting M, Theile G, Kruschinski C, Koschak J, Hummers-Pradier E, et al. Hausbesuche: Versorgungsforschung mit hausärztlichen Routinedaten von 158.000 Patienten [Home visits in German general practice: findings from routinely collected computer data of 158,000 patients]. Gesundheitswesen. 2007;69(12):679–85. doi:.https://doi.org/10.1055/s-2007-993181
  6. Heymann R, Weitmann K, Weiss S, Thierfelder D, Flessa S, Hoffmann W. Bevölkerungsdichte, Altersverteilung und Urbanität als Einflussfaktoren der Hausbesuchshäufigkeit – eine Analyse für Mecklenburg-Vorpommern [Population density, age distribution and urbanisation as factors influencing the frequency of home visits--an analysis for Mecklenburg-West Pomerania]. Gesundheitswesen. 2009;71(7):423–8. doi:.https://doi.org/10.1055/s-0029-1202798
  7. Schäfer I, Hansen H, Ruppel T, Lühmann D, Wagner HO, Kazek A, et al. Regional differences in reasons for consultation and general practitioners’ spectrum of services in northern Germany - results of a cross-sectional observational study. BMC Fam Pract. 2020;21(1):22. doi:.https://doi.org/10.1186/s12875-020-1093-6
  8. 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;20(1):3. doi:.https://doi.org/10.1186/s12875-018-0891-6
  9. Moth G, Vestergaard M, Vedsted P. Chronic care management in Danish general practice--a cross-sectional study of workload and multimorbidity. BMC Fam Pract. 2012;13(1):52. doi:.https://doi.org/10.1186/1471-2296-13-52
  10. Bähler C, Huber CA, Brüngger B, Reich O. Multimorbidity, health care utilization and costs in an elderly community-dwelling population: a claims data based observational study. BMC Health Serv Res. 2015;15(1):23. doi:.https://doi.org/10.1186/s12913-015-0698-2
  11. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43. doi:.https://doi.org/10.1016/S0140-6736(12)60240-2
  12. Campion EW. Can house calls survive? N Engl J Med. 1997;337(25):1840–1. doi:.https://doi.org/10.1056/NEJM199712183372511
  13. Boerma WGW, Groenewegen PP. GP home visiting in 18 European countries. Eur J Gen Pract. 2001;7(4):132–7. doi:.https://doi.org/10.3109/13814780109094331
  14. Cohidon C, Cornuz J, Senn N. Primary care in Switzerland: evolution of physicians’ profile and activities in twenty years (1993-2012). BMC Fam Pract. 2015;16(1):107. doi:.https://doi.org/10.1186/s12875-015-0321-y
  15. 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
  16. Lamers LM, Vliet RCJA. Health-based risk adjustment Improving the pharmacy-based cost group model to reduce gaming possibilities. Eur J Health Econ. 2003;4(2):107–14. doi:.https://doi.org/10.1007/s10198-002-0159-9
  17. Common Institution of Health Insurance Law. 2012. Gemeinsame Einrichtung Krankenversicherungsgesetz, KVG. https://www.kvg.org/de/risikoausgleich-_content---1--1047.html (last accessed 2021 April 16)
  18. R Core Team. R: A language and environment for statistical computing. In: Computing RFfS, editor. Vienna, Austria 2018.
  19. Joyce C, Piterman L. Trends in GP home visits. Aust Fam Physician. 2008;37(12):1039–42.
  20. Lykkegaard J, Larsen PV, Paulsen MS, Søndergaard J. General practitioners’ home visit tendency and readmission-free survival after COPD hospitalisation: a Danish nationwide cohort study. NPJ Prim Care Respir Med. 2014;24(1):14100. doi:.https://doi.org/10.1038/npjpcrm.2014.100
  21. 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
  22. Cornwell T. House calls are reaching the tipping point – now we need the workforce. J Patient Cent Res Rev. 2019;6(3):188–91. doi:.https://doi.org/10.17294/2330-0698.1719
  23. National Institute for Health and Care Excellence (NICE). Chapter 6 GP-led home visits. Emergency and acute medical care in over 16s: service delivery and organisation. NICE guideline 94. NICE; 2018
  24. Saultz JW. Defining and measuring interpersonal continuity of care. Ann Fam Med. 2003;1(3):134–43. doi:.https://doi.org/10.1370/afm.23
  25. Martínez-González NA, Rosemann T, Tandjung R, Djalali S. The effect of physician-nurse substitution in primary care in chronic diseases: a systematic review. Swiss Med Wkly. 2015;145:w14031. doi:.https://doi.org/10.4414/smw.2015.14031
  26. Yao NA, Rose K, LeBaron V, Camacho F, Boling P. Increasing role of nurse practitioners in house call programs. J Am Geriatr Soc. 2017;65(4):847–52. doi:.https://doi.org/10.1111/jgs.14698
  27. Gysin S, Bischofsberger I, Meier R, van Vught A, Merlo Ch, Essig S. Nurse Practitioners in Swiss Family Practices as Potentially Autonomous Poviders of Home Visits: An Exploratory Study of Two Cases. Home Health Care Manage Pract. 2021;3:1–6.
  28. Macdonald G, Vernon G, McNab D, Murdoch JC. Home visits for vulnerable older people: journeys to the ‘Far End’. Br J Gen Pract. 2020;70(699):479–80. doi:.https://doi.org/10.3399/bjgp20X712685
  29. Mitchell S, Hillman S, Rapley D, Gray SDP, Dale J. GP home visits: essential patient care or disposable relic? Br J Gen Pract. 2020;70(695):306–7. doi:.https://doi.org/10.3399/bjgp20X710345
  30. Huber CA, Schwenkglenks M, Rapold R, Reich O. Epidemiology and costs of diabetes mellitus in Switzerland: an analysis of health care claims data, 2006 and 2011. BMC Endocr Disord. 2014;14(1):44. doi:.https://doi.org/10.1186/1472-6823-14-44
  31. Haller E, Watzke B, Blozik E, Rosemann T, Reich O, Huber CA, et al. Antidepressant prescription practice and related factors in Switzerland: a cross-sectional analysis of health claims data. BMC Psychiatry. 2019;19(1):196. doi:.https://doi.org/10.1186/s12888-019-2178-4

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