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 of good family practice. Aim. To investigate the reasons why patients asked for home visits, the therapeutic procedures used, the equipment needed, and the diagnostic conclusions, 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 Israel. Seven hundred and ninety-nine usable records were analysed. Results. No overall difference was found in home visiting rates between rural 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 patients and 41% in rural practices (P = 0.008). The most common reason for requesting a home visit was for undefined general symptoms, but the doctor was usually able to arrive at a more specific diagnosis after the visit. Medication 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%, electrocardiograph in 13%, and a blood glucose meter in 9% of home visits. Conclusions. Home visiting in rural practices involves more active intervention on the part of the doctor, whereas, in urban practices, visits to chronically house-bound patients predominate. During the home visit, the patient's complaint is translated by the doctor into an organ-specific or a system-specific diagnosis, and in many cases support is provided for the caregiver. The equipment the doctor carries to home visits may not be the equipment most needed.