HOME VISITING BY GENERAL-PRACTITIONERS IN ENGLAND AND WALES

Objective-To use data from the fourth national survey of morbidity in general practice to investigate the association between home visiting rates and patients' characteristics. Design-Survey of diagnostic data on all home visits by general practitioners. Setting-60 general practi ces in England and Wales. Subjects-502 493 patients visited at home be tween September 1991 and August 1992. Main outcome measures-Home visit ing rates per 1000 patient years and home visiting ratios standardised for age and sex. Results-10.1% (139 801/1 378 510) of contacts with g eneral practitioners took place in patients' homes. The average annual home visiting rate was 299/1000 patient years. Rates showed a J shape d relation with age and were lowest in people aged 16-24 years (103/10 00) and highest in people aged greater than or equal to 85 years (3009 /1000). 1.3% of patients were visited five or more times and received 39% of visits. Age and sex standardised home visiting ratios increased from 69 (95% confidence interval 68 to 70) in social class I to 129 ( 128 to 130) in social class V. The commonest diagnostic group was dise ases of the respiratory system. In older age groups, diseases of the c irculatory system was also a common diagnostic group. Standardised hom e visiting ratios for the 60 practices in the study varied nearly eigh tfold, from 28 to 218 (interquartile range 67 to 126). Conclusions-Hom e visits remain an important component of general practitioners' workl oad. As well as the strong associations between home visiting rates an d patient characteristics, there were also large differences between p ractices in home visiting rates. A small number of patients received a disproportionately high number of home visits. Further investigation of patients with high home visiting rates may help to explain the larg e differences in workload between general practices and help in alloca tion of resources to practices.