The place of home visiting in family practice: a multicentre comparison between rural and urban physicians

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.