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Home visits and family physician

Article · January 2019

DOI: 10.4103/mjdrdypu.mjdrdypu_235_18

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Vadish Bhat
K.S. Hegde Medical Academy
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 spine
4.5 mm

Print ISSN: 2589-8302

E-ISSN: 2589-8310

Medical Journal
Medical Journal of Dr. D.Y. Patil Vidyapeeth

of
Dr.DY Patil Vidyapeeth
(Deemed to be University)
•

Official Publication of Dr. DY Patil Vidyapeeth Society, Pune

Volume 12

Volume 12 / Issue 2 / March-April 2019

www.mjdrdypv.org
•
Issue 2
•
March-April 2019
•
Pages ***-***
Editorial Commentary
Home Visits and Family Physician
Home visits were routine for an Indian family physician
in olden days. Attending a sick person at his residence
was a common practice of a family physician, and the
diagnosis was mainly based on the clinical knowledge of
symptoms and signs of disease. This was more common
in a rural setup, where due to the lack of transport
facility, shifting a sick person to the doctor’s clinic was
not possible. The reason for home visit varies from a
routine health checkup to a real emergency condition.
With the increase in life expectancy of the population,
there is an increase in the number of people seeking
in‑home care worldwide. In India, the population of
elderly people is growing and likely to triple in another
10 years.
The practice of home visits is also common in the
United States, Europe, and Canada. Until the 1940s, the
majority of physicians in America and Britain used to
conduct home visits, and hence, they spend a lot of time
in traveling from one place to another.[1] In America,
about 50% of primary care physicians conduct home
visits, though many of them do only a few visits every
year. Lack of reimbursement and the busy schedule in
clinic‑based practice and time spent in traveling are the
factors cited for not attending house calls.[2]
Family physicians can provide most of the care to
elderly, during a home visit. For conducting an effective
home visit, a physician must acquire basic knowledge,
attitude, and skill apart from having a portable set of
basic equipment.[2] Home visits, apart from performing
the clinical examination, also allow the physician to
assess patients living condition and the family supports.
Knight and Adelman defined the things to be assessed
during a home visit, with a mnemonic INHOME, which
includes Immobility, Nutrition, Housing, Other people,
Medications, and Examination; later, this is further
expanded as INHOMESS with the addition of Safety
and Spiritual health.[3]
In the United States of America, in‑home care has grown
rapidly after 1978. One important factor for such growth
is the health insurance by the Medicare prospective
payment system, where the expenses are reimbursed if
the home health care is planned by the doctor and the
care is received from a Medicare‑certified home health
agency.[4]
If the home visits are not planned and organized wisely,
this can adversely affect one’s clinical practice.[2] In
India, there are few start‑ups which facilitate home
visits of doctors for needy patients and provide a variety
of health‑care services such as primary care, chronic
© 2019 Medical Journal of Dr. D.Y. Patil Vidyapeeth | Published by Wolters Kluwer - Medknow
disease management, geriatric care, and postoperative
care in the home setting.[5,6] However, medical insurance
companies need to be made aware of the importance of
home care, especially by reducing the duration of the
hospital stay, thereby the insurance cover may also be
extended to home health care.
The teaching of home care is not given due importance
in the medical education curriculum. Even though an old
practice, home care fell into disuse, and restoring it is
difficult. Community medicine gives an opportunity for
home visits; however, emphasis is more on preventive
medicine. Neale et  al. developed a home visit rotation
program for family medicine residents to provide a
comprehensive understanding of home health care,
with particular importance on geriatric, community,
and rehabilitative medicine. Evaluation of the program
suggested that at the end of the rotation posting,
residents are more likely to agree that home visits are an
essential part of residency training.[7]
Jakubovicz and Srivastava evaluated a training
program for family practice residents by allocating a
family to each resident and a longitudinal follow‑up
of 2 years, with a rationale of developing a sense of
ownership and responsibility among residents for their
assigned homebound patients. They concluded that
residents’ willingness to provide home visits did not
increase over the course of the residency, but their
confidence in making house calls did increase. There
was also a trend toward increased confidence among
residents in working with community agencies.[8] With
a growing population of elderly and with the rising
cost of institutional care, home services need to be
considered as a core competency for family practice
residents. Scientific publications about home visits and
the training of residents about home visits are lacking
in Indian literature. There is a need for research and
publications to emphasize the importance of home visits
and generate interest in the home health care among the
residents.
The “black bag” of an olden day doctor may now
contain a digital thermometer, pulse oximeter, and a
digital sphygmomanometer, but the aim of the bag will
remain the same.[1] Properly conducted home visits can
enhance the patient–doctor relationship, apart from
cost‑effective delivery of health care.
Vadisha Bhat
Department of Otorhinolaryngology, K S Hegde Medical
Academy, Mangalore, Karnataka, India
E‑mail: bvadish@yahoo.co.in
101
 Bhat: Home visits and family physician

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Med J 2012;89:175‑7.
2. Unwin  BK, Jerant  AF. The home visit. Am Fam Physician
1999;60:1481‑8.
3. Knight AL, Adelman AM. The family physician and home care.
Am Fam Physician 1991;44:1733‑7.
Physician 2015;61:e189‑95.
This is an open access journal, and articles are distributed under the terms of the
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terms.

4. Swan JH, Mahoney C, Hunter H. In‑home physician visits and

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5. Available from: https://www.homehealthcarenews.com/2018/01/ Quick Response Code:
why­-indias­-home­-health­-start‑ups‑are‑raising‑serious‑fundi Website:
www.mjdrdypv.org
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7. Neale AV, Hodgkins BJ, Demers RY. The home visit in resident
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1992;24:36‑40. How to cite this article: Bhat V. Home visits and family physician. Med J
8. Jakubovicz D, Srivastava A. Home visits in family medicine DY Patil Vidyapeeth 2019;12:101-2.

102 Medical Journal of Dr. D.Y. Patil Vidyapeeth  ¦  Volume 12  ¦  Issue 2  ¦  March-April 2019

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