Which physicians make home visits and why? A survey

Background: Recent changes in the North American health care system and cer tain demographic factors have led to increases in home care services. Littl e information is available to identify the strategies that could facilitate this transformation in medical practice and ensure that such changes respo nd adequately to patients' needs. As a first step, the authors attempted to identify the major factors influencing physicians' home care practices in the Quebec City area. Methods: A self-administered questionnaire was sent by mail to all 696 gene ral practitioners working in the Quebec City area. The questionnaire was in tended to gather information on physicians' personal and professional chara cteristics, as well as their home care practice (practice volume, character istics of both clients and home visits, and methods of patient assessment a nd follow-up). Results: A total of 487 physicians (70.0%) responded to the questionnaire, 283 (58.1%) of whom reported making home visits. Of these, 119 (42.0%) made fewer than 5 home visits per week, and 88 (31.1%) dedicated 3 hours or les s each week to this activity. Physicians in private practice made more home visits than their counterparts in family medicine units and CLSCs (centres locaux des services communautaires [community centres for social and healt h services]) (mean 11.5 v. 5.8 visits per week), although the 2 groups repo rted spending about the same amount of time on this type of work (mean 5.6 v. 5.0 hours per week). The proportion of visits to patients in residential facilities or other private residences was greater for private practitione rs than for physicians from family medicine units and CLSCs (29.7% v. 18.9% of visits), as were the proportions of visits made at the patient's reques t (28.0% v. 14.2% of visits) and resulting from an acute condition (21.4% v . 16.0% of visits). The proportion of physicians making home visits at the request of a CLSC was greater for those in family medicine units and CLSCs than for those in private practice (44.0% v. 11.3% of physicians), as was t he proportion of physicians making home visits at the request of a colleagu e (18.0% v. 4.5%) or at the request of hospitals (30.0% v. 6.8%). Physician s in family medicine units and CLSCs did more follow-ups at a frequency of less than once per month than private practitioners (50.9% v. 37.1% of pati ents), and they treated a greater proportion of patients with cognitive dis orders (17.2% v. 12.6% of patients) and palliative care needs (13.7% v. 8.6 % of patients). Private practitioners made less use of CLSC resources to as sess home patients or follow them. Male private practitioners made more hom e visits than their female counterparts (mean 12.8 v. 8.3 per week), althou gh they spent an almost equal amount of time on this activity (mean 5.7 v. 5.2 hours per week). Interpretation: These results suggest that practice patterns for home care vary according to the physician's practice setting and sex. Because of fore seeable increases in the numbers of patients needing home care, further res earch is required to evaluate how physicians' practices can be adapted to p atients' needs in this area.