S. Nakar et al., The place of home visiting in family practice: a multicentre comparison between rural and urban physicians, BR J GEN PR, 49(445), 1999, pp. 621-625
Background. There is a worldwide trend towards a reduction in the number of
house calls made by family physicians. House calls are still the essence o
f good family practice.
Aim. To investigate the reasons why patients asked for home visits, the the
rapeutic procedures used, the equipment needed, and the diagnostic conclusi
ons, in urban and rural settings.
Method. The details of 10 consecutive home visits were recorded by each of
91 family doctors serving 125 000 patients in urban and rural regions of Is
rael. Seven hundred and ninety-nine usable records were analysed.
Results. No overall difference was found in home visiting rates between rur
al and urban physicians, but rural physicians made more out-of-hours visits
than urban physicians (P = 0.016). Sixty-seven per cent of the visits were
to the elderly; in urban practices, 53% visits were made to housebound pat
ients and 41% in rural practices (P = 0.008). The most common reason for re
questing a home visit was for undefined general symptoms, but the doctor wa
s usually able to arrive at a more specific diagnosis after the visit. Medi
cation was administered directly in 41% of rural visits and in 24% of urban
visits (P<0.001). The commonest drugs used were antipyretics. Prescription
pads were needed in 73% of urban visits and 48% of rural visits (P<0.001).
A stethoscope was needed in 83%, sphygmomanometer in 67%, electrocardiogra
ph in 73%, and a blood glucose meter in 9% of home visits.
Conclusions. Home visiting in rural practices involves more active interven
tion on the part of the doctor, whereas, in urban practices, visits to chro
nically house-bound patients predominate. During the home visit, the patien
t's complaint is translated by the doctor into an organ-specific or a syste
m-specific diagnosis, and in many cases support is provided for the caregiv
er. The equipment the doctor carries to home visits may not be the equipmen
t most needed.