WHEN THE PATIENT CANNOT COME TO THE DOCTOR - A MEDICAL HOUSECALLS PROGRAM

OBJECTIVES: To describe a medical housecalls program and to assess its ability to meet the medical needs of homebound patients. PROGRAM STRU CTURE: The housecalls program is parr of a larger ambulatory practice situated in a senior center staffed by geriatricians and nurse practit ioners; The practice serves as the major teaching site of outpatient g eriatrics for a medical residency program. Scheduled visits are made e very S to 4 months, and unscheduled visits are made weekday days for a cute problems. PARTICIPANTS: Patients are eligible for the housecalls program if they live within a 15-minute drive of the center and are un able to leave their home. PROGRAM EVALUATION: The majority of the 71 p atients in the housecalls program between 1993 and 1995 were female (8 1%), aged 85 years or older (52%), and dependent in one or more activi ties of daily living: 65% were dependent in bathing and 42% in dressin g. A substantial minority (16%) had severe cognitive impairment. Patie nts received a mean of 5.0 visits per patient-year. The majority of pa tients (59%) were treated at home for an acute illness or symptom rang ing from upper respiratory tract infections to pneumonia and congestiv e heart failure. Approximately one-quarter of the patients or their pr oxies elected to avoid hospitalization; several of these patients had complex illnesses managed in their homes, CONCLUSIONS: A wide range of medical problems can be addressed in patients' homes. Because Our pat ients could not leave their homes easily, or at all, it is probable th ey would not have received routine medical care and would have used th e emergency room for evaluation of acute problems if the housecalls pr ogram were not available. Despite their potential value in the care of frail older patients, housecalls will likely not become a widespread practice until barriers to their performance cited by physicians are a ddressed.