One of the most memorable experiences of my medical training was my first home visit. I was a medical student participating in a primary care elective with a physician in Nashville, Tennessee. In addition to gaining experience in the clinic setting, I was expected to make a visit to a clinic patient in his/her home. I imagined entering the patient’s home with black bag in hand, taking vital signs, listening intently and providing expertise before moving on to another patient in need.
My actual visit was more complex than that. Visiting with the patient in her cluttered living room with medications piled in a bucket on the floor, we discussed her health challenges and the difficulties that she had with keeping her scheduled appointments not only with her primary care doctor, but also with specialists. Seeing her home environment brought an immediate context to her tenuous health status. When I saw my supervising physician the next day, I remarked at how revealing the experience was.
It is estimated that about 12 million Americans receive home care services that include home visits by doctors, nurses and other health professionals.1 And research has shown just how useful home visits can be for chronically ill patients. For example, the Department of Veterans Affairs’ Home Based Primary Care program — which provides comprehensive care in the home setting to patients with chronic illness — has reduced the total number of days for hospital care among its enrollees by over 75 percent.2 This translates into thousands of dollars saved per patient.
“The home visit is a precious window into patients’ lives,” says Laura Sander, a general internist at Johns Hopkins Community Physicians East Baltimore Medical Center. Sander is the medical director for the Priority Access Primary Care program, a Johns Hopkins initiative that provides intensive follow-up and coordination of care for underserved patients with complex medical needs. As part of the program, she often visits patients at home to tie up loose ends. She hopes that her efforts can keep these high-risk patients out of the hospital.
“Our sickest and most vulnerable patients benefit greatly from added care and attention,” says Sander. And a home visit can help provide just that.
I accompanied Sander and the team clinical social worker on a visit to a patient’s house. Sitting on her sofa, we reviewed each of her medications to ensure that all were present. We then evaluated her symptoms for which she had been treated, and she reported that the symptoms improved. Her smiling face at the end of the visit showed her appreciation for the time spent with her.
Sander is hopeful that innovations in clinical care will make home visits a regular part of practice for more doctors.
"When this attention is placed at the primary care level, the whole system benefits,” she says.
1Basic statistics about home care. 2010. National Association for Home Care and Hospice. Accessed July 26, 2015. www.nahc.org/assets/1/7/10HC_Stats.pdf.
2Beales, J. and Edes, T. 2009. Veteran’s affairs home based primary care. Clinics in Geriatric Medicine 25(1): 149-154.