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Nonaka S, Odaka M, Takada A, Senoo Y, Sawano T, Ozaki A, Murakami M, Yoshida M, Uchi Y, Onoda K, Oikawa T, Tsubokura M. Primary care clinic visits in formerly evacuated areas due to radiation disaster following the Great East Japan Earthquake: A retrospective descriptive study. Medicine (Baltimore) 2024; 103:e37942. [PMID: 38701284 PMCID: PMC11062722 DOI: 10.1097/md.0000000000037942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/29/2024] [Indexed: 05/05/2024] Open
Abstract
Radiation disasters pose distinctive medical challenges, requiring diverse care approaches. Beyond radiation exposure assessment, addressing health impacts due to lifestyle changes, especially among vulnerable populations, is vital. Evacuation orders issued in radiation-affected areas introduce unique healthcare dynamics, with their duration significantly influencing the recovery process. Understanding evolving patient demographics and medical needs after lifting evacuation orders is crucial for post-disaster care planning. Minamisoma Municipal Odaka Hospital, located 13 to 20 km from Fukushima Daiichi Nuclear power plant in a post-evacuation zone, was greatly affected by the Great East Japan Earthquake and subsequent radiation disaster. Data were retrospectively collected from patient records, including age, gender, visit date, diagnoses, and addresses. Patient records from April 2014 to March 2020 were analyzed, comparing data before and after the July 2016 evacuation order lift. Data was categorized into pre and post-evacuation order lifting periods, using International Classification of Diseases, Tenth Edition codes, to identify the top diseases. Statistical analyses, including χ-square tests, assessed changes in disease distributions. Population data for Odaka Ward and Minamisoma City fluctuated after lifting evacuation orders. As of March 11, 2011, Odaka Ward had 12,842 residents (27.8% aged 65+ years), dropping to 8406 registered residents and 2732 actual residents by April 30, 2018 (49.7%). Minamisoma City also saw declines, with registered residents decreasing from 71,561 (25.9%) to 61,049 (34.1%). The study analyzed 11,100 patients, mostly older patients (75.1%), between 2014 and 2020. Post-lifting, monthly patient numbers surged from an average of 55.2 to 213.5, with female patients increasing from 33.8% to 51.7%. Disease patterns shifted, with musculoskeletal cases declining from 23.8% to 13.0%, psychiatric disorders increasing from 9.3% to 15.4%, and trauma-related cases decreasing from 14.3% to 3.9%. Hypertension (57.1%) and dyslipidemia (29.2%) prevailed post-lifting. Urgent cases decreased from 1.3% to 0.1%. This study emphasizes the importance of primary care in post-evacuation zones, addressing diverse medical needs, including trauma, noncommunicable diseases, and psychiatric disorders. Changing patient demographics require adaptable healthcare strategies and resource allocation to meet growing demands. Establishing a comprehensive health maintenance system tailored to these areas' unique challenges is crucial for future disaster recovery efforts.
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Affiliation(s)
- Saori Nonaka
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
- Research Center for Community Health, Minamisoma Municipal General Hospital, Fukushima, Japan
- Department of General Medicine, Taito Hospital, Japan Association for Development of Community Medicine, Tokyo, Japan
| | - Masaaki Odaka
- Clinic Director, Odaka Clinic Affiliated with Minamisoma Municipal General Hospital, Fukushima, Japan
| | - Akemi Takada
- Department of Nursing, Odaka Clinic Affiliated with Minamisoma Municipal General Hospital, Fukushima, Japan
| | - Yuki Senoo
- Department of Internal Medicine, Higashi-Totsuka Memorial Hospital, Kanagawa, Japan
| | - Toyoaki Sawano
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
- Research Center for Community Health, Minamisoma Municipal General Hospital, Fukushima, Japan
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Fukushima, Japan
| | - Akihiko Ozaki
- Research Center for Community Health, Minamisoma Municipal General Hospital, Fukushima, Japan
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Fukushima, Japan
| | - Michio Murakami
- Department of Health Risk Communication, Fukushima Medical University School of Medicine, Fukushima, Japan
- Center for Infectious Disease Education and Research (CiDER), Osaka University, Osaka, Japan (current address)
| | - Makoto Yoshida
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuna Uchi
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Katsuko Onoda
- Department of Nursing, Minamisoma Municipal General Hospital, Fukushima, Japan
| | - Tomoyoshi Oikawa
- Department of Neurosurgery, Minamisoma Municipal General Hospital, Fukushima, Japan
| | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
- Research Center for Community Health, Minamisoma Municipal General Hospital, Fukushima, Japan
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Seah JY. Barriers to Making House Calls by Primary Care Physicians and Solutions: A Literature Review. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2020; 15:3-9. [PMID: 33329858 PMCID: PMC7735878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND The number of house calls made by physicians has been declining over the years, while the number of people requiring house calls, especially the elderly, is growing. AIM To consolidate the literature regarding the barriers faced by primary care physicians in making house calls. DESIGN OF THE STUDY Literature review. METHOD Studies were sourced from PubMed and Embase. RESULTS 7 studies were selected to be in the literature review. Barriers to making house calls by primary care physicians include inadequate remuneration, lack of time and training, unconducive home environment, concerns with professional liability and safety, and perceived low value-added in the patient's quality of care. CONCLUSION While primary care physicians do recognize the value of house calls in patient care, the perceived limited standard of care that can be achieved in the home setting, busy clinic practice (large patient loads), coupled with inadequate remuneration make house calls unrealistic for many doctors. These barriers must be addressed to ensure accessibility to primary health care services for the immobile, frail, and sick is not being compromised. One of the solutions may be to expose medical students and residents to house calls early through mentorship.
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Affiliation(s)
- J Y Seah
- Medical student at Yong Loo Lin, School of Medicine, National University of Singapore, Singapore,
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Timmermans S, Freidin B. Caretaking as articulation work: the effects of taking up responsibility for a child with asthma on labor force participation. Soc Sci Med 2007; 65:1351-63. [PMID: 17590253 DOI: 10.1016/j.socscimed.2007.05.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Indexed: 11/20/2022]
Abstract
A well-established quantitative literature has documented the financial toll for women's caretaking. Still, we do not know much about the process by which women end up taking on an extensive caretaking role and what they do on a daily basis. Based on in-depth interviews with a convenience sample of fifty caretakers of school aged children with asthma and nine health professionals in the USA, this study examines how health professionals socialize mothers into an intensive caretaking role for their children with asthma, how mothers negotiated and perform that role, and the impact of care work on their labor force participation. Care providers assign broad caretaking tasks that require further articulation work to get the job done. Although mothers care for their children in varied ways, caring for a child with a chronic disease remains a time-consuming activity. Mothers pay a price for the indeterminate nature of articulation work by scaling back their involvement in the paid labor force.
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Affiliation(s)
- Stefan Timmermans
- Department of Sociology, 264 Haines Hall, 375 Portola plaza, UCLA, Los Angeles, CA 90095-1551, USA.
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Abstract
O atendimento domiciliar ao idoso tem se tornado um importante instrumento de assistência nos últimos anos, tanto nos países desenvolvidos quanto nos países em desenvolvimento. Vários aspectos éticos, sociais e operacionais têm sido negligenciados e a literatura nacional é escassa em relação a esta temática. A partir de revisão bibliográfica em atendimento domiciliar, este artigo enfoca, do ponto de vista bioético, os potenciais problemas advindos com a implantação dessa crescente e importante modalidade de atendimento. Conclui ser necessário um maior direcionamento ético na implantação do atendimento domiciliar, com políticas de proteção ao paciente, à família e ao cuidador, visando a aperfeiçoar a qualidade dos programas oferecidos.
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Ricauda NA, Bo M, Molaschi M, Massaia M, Salerno D, Amati D, Tibaldi V, Fabris F. Home Hospitalization Service for Acute Uncomplicated First Ischemic Stroke in Elderly Patients: A Randomized Trial. J Am Geriatr Soc 2004; 52:278-83. [PMID: 14728641 DOI: 10.1111/j.1532-5415.2004.52069.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate whether home treatment of elderly patients with acute uncomplicated first ischemic stroke is associated with different mortality rates and clinical outcomes from those of patients treated on a general medical ward (GMW). DESIGN Randomized, controlled, single-blind trial. SETTING S. Giovanni Battista Hospital of Turin. PARTICIPANTS One hundred twenty elderly patients admitted to the emergency department of the hospital with first acute ischemic stroke were randomized to home treatment from a geriatric home hospitalization service (GHHS) or to GMW treatment. MEASUREMENT Main outcome was cumulative survival at 6 months in the two groups. Residual functional impairment, neurological deficit, depression, morbidity, and admission to rehabilitation and long-term care facilities were considered as secondary outcomes in survivors. RESULTS One hundred twenty patients (mean age 82; 54 men and 66 women) were enrolled (60 in each study arm). The cumulative proportion of cases surviving at 6 months was 0.65 in the GHHS group and 0.60 in GMW group (log-rank test P=.53). Functional and neurological parameters were significantly improved in both GHHS and GMW patients, without significant differences between the two groups. Depression score was significantly better in home-treated patients (P<.001), who were more likely to remain at home at 6 months than hospital-treated patients and had a lower rate of select medical complications. CONCLUSION Home-treated elderly patients with ischemic stroke have better depressive scores and lower rates of admission to nursing homes. These results should prompt further studies to evaluate home hospitalization for elderly stroke patients.
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Muramatsu N, Cornwell T. Needs for physician housecalls--views from health and social service providers. Home Health Care Serv Q 2003; 22:17-29. [PMID: 12870710 DOI: 10.1300/j027v22n02_02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This article examines how the role of a physician housecall program is perceived by health and social service providers that refer their clients to the program in a Midwest suburban community. Focus groups and semi-structured interviews with those providers revealed various housecall service needs of their homebound clients. In particular, the fact that home health agencies were the largest referral source suggests that the housecall program fills the needs that are not met by the current mainstream home health services. Our findings reinforce the argument for the increased physician involvement in home care and physician housecalls.
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Affiliation(s)
- Naoko Muramatsu
- University of Illinois at Chicago School of Public Health, 1603 West Taylor Street, Chicago, IL 60612-4394, USA.
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Leff B, Burton JR. The future history of home care and physician house calls in the United States. J Gerontol A Biol Sci Med Sci 2001; 56:M603-8. [PMID: 11584032 DOI: 10.1093/gerona/56.10.m603] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Over the last 20 years, home care has experienced significant change. The home care industry developed into big business and a number of innovative models of home care were developed and evaluated. Although physicians perform many fewer house calls than a half-century ago, there has been a recent revival in house-call training, education, and practice. In addition, telemedicine and other technologies hold great promise for the future of home care. However, the future history of home care will depend mostly on the ability of various stakeholders in the health care system to recognize the value of home care and develop and implement the appropriate incentives to encourage its proper place in the U.S. health care system.
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Affiliation(s)
- B Leff
- School of Medicine, Johns Hopkins University, Baltimore, Maryland 21224, USA.
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Bernstein AB, Hing E, Burt CW, Hall MJ. Trend data on medical encounters: tracking a moving target. Health Aff (Millwood) 2001; 20:58-72. [PMID: 11260959 DOI: 10.1377/hlthaff.20.2.58] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The National Health Care Survey (NHCS), conducted by the National Center for Health Statistics, consists of separate data collection activities that can be used to track the number and content of health care encounters in the United States. Tracking even something as simple as the number of encounters, however, is complicated by the fact that the content of these encounters changes over time. Results from the NHCS indicate that the U.S. population has been receiving more drugs, more cardiac procedures, more ambulatory surgery, more therapies in nursing homes, and more home health care over time. Policymakers and researchers who examine health care trends should be wary about judging whether the number of length of encounters is positive or negative without also examining the content of these encounters.
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Affiliation(s)
- A B Bernstein
- Development and Analysis Group, Division of Health Care Statistics, National Center for Health Statistics, Hyattsville, Maryland, USA
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Abstract
The rapid growth of the geriatric sector of the population has, in part, led to the explosion of the home care industry and the rebirth of the house call. Understanding the population being served is always the first step in providing excellent care. Older people who are frail and homebound have physical, social, and emotional needs that require careful assessment and team intervention in the home. To provide care, the practitioner must establish trust with the patient and the caregivers. Often, the agenda of the patient, family, and physician differ. A multidisciplinary team can offer help to meet the needs of each party. Allowing the patient to be an active participant in the care plan is paramount. Changes should be made slowly with careful explanation and education at each step, and the right of an individual to refuse treatment should be respected. Support for the caregiver and accessibility for consultation and advice can make a difference in the quality of care an older individual receives.
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Affiliation(s)
- V LoFaso
- Division of Geriatrics and Gerontology, New York Hospital-Cornell Medical Center, New York, USA
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Abstract
BACKGROUND Despite the growth in other home health care services, the number of house calls by physicians has declined dramatically during this century. We determined the frequency of house calls made by physicians to elderly U.S. patients in 1993 and analyzed the characteristics of the physicians and patients involved. METHODS We analyzed a 5 percent random sample of the 1993 Medicare Part B claims data for beneficiaries over the age of 65 who were not enrolled in health maintenance organizations (HMOs). With supplemental information from the Area Resource File and the American Medical Association's Physician Masterfile, we determined how many house calls were made, their cost, and a number of specific characteristics of the physicians and the patients. RESULTS In our 1993 sample, 36,350 house calls were made to 11,917 of the 1,357,262 patients. When extrapolated to all Medicare beneficiaries over age 65 and not enrolled in HMOs, these figures correspond to 727,000 house calls to 238,340 patients nationwide. We estimated the cost of these house calls to be $63 million. The patients who received house calls from physicians were older than those who did not, were more likely to die within the calendar year, had higher rates of hospitalization, and were more likely to receive care from other home health providers, hospice programs, and skilled-nursing facilities. Patients residing in rural areas and those in areas with high physician-to-population ratios had an increased likelihood of receiving a house call. The physicians who made house calls were more likely than others to be generalists, osteopaths, older, male, board-certified, practicing in the Northeast, and in solo practice. CONCLUSIONS A very small percentage (0.88 percent) of elderly Medicare patients, mainly those who are very sick and near the end of life, receive house calls from physicians.
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Affiliation(s)
- G S Meyer
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Sessa C, Roggero E, Pampallona S, Regazzoni S, Ghielmini M, Lang M, Marx B, Neuenschwander H, Pagani O, Vasilievic V, Cavalli F. The last 3 months of life of cancer patients: medical aspects and role of home-care services in southern Switzerland. Support Care Cancer 1996; 4:180-5. [PMID: 8739649 DOI: 10.1007/bf01682337] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The clinical data on terminal cancer patients who have died since the establishment of a program of collaboration between community services and the cancer center of Canton of Ticino, southern Switzerland, were retrospectively analyzed to describe the characteristics of patients seen and the effect on them of a home-care program coordinated by the cancer center. The home-care program is based on five geographically grouped community-based domiciliary services, with the addition of one nurse responsible for coordination and one physician from the oncology center. Selection criteria for participation in the home-care program are defined. The main outcome measures were: number of hospitalizations and median hospital stay during the last 3 months of life; reasons for and median length of last hospitalization; place of death of patients who had home care and those who did not. In the group of 993 patients analyzed, the median contact time with the cancer center was 9.5 months (10th percentile: 1 month, 90th percentile: 71 months); the most frequent neoplasm was lung cancer (22%) with the briefest contact time (7.5 months; 10th percentile: 1 month; 90th percentile: 21 months); 13.5% of patients were never hospitalized; half of the patients had a total hospital stay of 24 days or longer and 23% died at home. The sociodemographic and medical characteristics of home-care users were similar to those of the home-care non-users and to those of the overall group. In the group of home-care users (32% of the total) 22% were never hospitalized, half of the patients had a total hospital stay of 17 days or longer, and 43.5% of them died at home. These values were significantly different (P > 0.001) from those reported in the group of home-care non-users. Palliative care, provided at home through community-based domiciliary services, is associated with less frequent and shorter hospitalizations in the last 3 months of life. Medical oncology and palliative treatments should be mutually complementary to improve patients care. Cancer centers should be involved in the planning and coordination of supportive-care domiciliary services.
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Affiliation(s)
- C Sessa
- Servizio Oncologico Cantonale, Ospedale San Giovanni, Bellinzona, Switzerland
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Kapp MB. Family caregiving for older persons in the home. Medical-legal implications. THE JOURNAL OF LEGAL MEDICINE 1995; 16:1-31. [PMID: 7738438 DOI: 10.1080/01947649509510964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Affiliation(s)
- M B Kapp
- Office of Geriatric Medicine & Gerontology, Wright State University School of Medicine, Dayton, OH, USA
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Keenan JM, Bland CJ, Webster L, Myers S. The home care practice and attitudes of Minnesota family physicians. J Am Geriatr Soc 1991; 39:1100-4. [PMID: 1753049 DOI: 10.1111/j.1532-5415.1991.tb02876.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Assess home care practice and attitudes of Minnesota family physicians (FPs). DESIGN Mailed survey. SETTING State of Minnesota. PARTICIPANTS Members of the Minnesota Academy of Family Physicians, 80% of the FPs practicing in the state. INTERVENTION A 55-item mailed, self-complete questionnaire regarding general practice and personal physician characteristics (18 questions), specific questions regarding geriatric and home care practice and related attitudes (37 questions); up to four reminder or follow-up surveys were sent. MAIN OUTCOME MEASURES Descriptive summary of FP home care practice and attitudes. RESULTS Eighty percent of surveys were completed, 76% of responding physicians made at least one home visit in the previous year, and 92% of home visits were to geriatric patients. Discriminant function analysis identified six significant (P less than 0.001) variables that explained 52% of the variance (r2 = 0.52, Wilks Lambda = 0.48) in home visiting behavior between frequent home visiting FPs (greater than 24 visits/year) and non-visiting FPs. FPs most likely to do home visiting were older and tended to have small group or solo practices in rural settings. CONCLUSION The survey documented continued decline (from previously published surveys) of physician home visiting behavior and widespread dissatisfaction with reimbursement. However, attitudes regarding home care provided by other professionals were highly positive.
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Affiliation(s)
- J M Keenan
- University of Minnesota Medical School, Department of Family Practice and Community Health, Minneapolis
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Steel K. "Homeward bound". AGING (MILAN, ITALY) 1991; 3:199-202. [PMID: 1764487 DOI: 10.1007/bf03324005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Boling PA, Retchin SM, Ellis J, Pancoast SA. Factors associated with the frequency of house calls by primary care physicians. J Gen Intern Med 1991; 6:335-40. [PMID: 1890505 DOI: 10.1007/bf02597433] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate factors associated with the frequency of house calls by primary care physicians. DESIGN A cross-sectional design with a self-administered mailed survey. SITTING/PARTICIPANTS: 751 primary care physicians who care for Medicaid patients in Virginia. RESULTS Among 389 physician respondents (52%), regular house callers (n = 216) were compared with occasional house callers (n = 162). Among physician characteristics, specialty and practice duration were associated with house call frequency. Regular house callers also more often cited chronic illness (67% vs. 20%, p less than 0.01) and terminal illness (67% vs. 40%, p less than 0.01) as indications for house calls, compared with occasional house callers. Use of visiting nurses to substitute for physician house calls was less often considered appropriate by frequent house callers (7% vs. 24%, p less than 0.01), and regular house callers were less likely to report being "too busy" to make house calls (71% vs. 29%, p less than 0.01). Multivariate analysis confirmed the association of these attitudes with house call frequency. CONCLUSION These data suggest that specific attitudes among primary care physicians are associated with house call frequency.
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Affiliation(s)
- P A Boling
- Department of Internal Medicine, Medical College of Virginia, Richmond
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Friedman B. A new paradigm for home care. J Am Geriatr Soc 1991; 39:223-4. [PMID: 1899439 DOI: 10.1111/j.1532-5415.1991.tb01634.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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