Introduction
In Poland, as in most other countries, office consultations and home visits are the main activities of family physicians. Apart from giving advice or examinations, the family physician has the opportunity to obtain valuable information on a patient's living conditions, family relations, and lifestyle. However, in many European countries, the number of home visits carried out by family physicians is showing a falling tendency Citation[1–3].
Considering the importance of professional medical home care in providing a high-quality primary healthcare service, we made an attempt to investigate the tendency of changes in home visits by family physicians in the years 1998, 2004, and 2006 from the patient's perspective. The study objective was to find out: 1) what percentage of patients reported the need for home visits in the family medicine service during the previous year; and 2) whether age, sex, and present history of chronic disease had an effect on making home-visit appointments.
Methods
Three surveys were performed at 4-year intervals (1998, 2002, and 2006), each involving 1000 subjects. On each occasion, the sample was established by means of random selection after selecting a subgroup of patients using medical services provided by family physicians and/or family nurses within the previous week.
The surveys were performed in Gizycko (Warmia and Mazury Province) in the north of Poland. Since 1995, family physicians have been contracted with a financial institution (currently the National Health Fund; NHF). Within the study period, 16 family physicians worked in this area. In 2006, the population of patients using the service was 33 500.
A structured questionnaire was used, the same type in each survey. The information was collected by means of face-to-face interviews. The respondents were interviewed in their homes by trained interviewers.
Results
The study results showed a significant decrease in the percentage of patients having made home-visit appointments with family physicians within the previous 12 months (survey I: 250 subjects, i.e., 25% of all respondents; survey II: 226 [22.6%]; survey III: 149 [14.9%]). A falling tendency was noted between surveys I and II, and a statistically significant decrease between surveys II and III (p<0.0001). With respect to age, a decrease was observed in the group of young patients (age group under 24 and 25–44 years) and an increase in the group of elderly patients (65 years and over) who had made home-visit appointments with family physicians. The difference was statistically significant (p<0.0001) ().
Table I. Home visits by family physicians in the previous 12 months in relation to age, sex, and presence of chronic disease.
Women and chronic sufferers were the predominant groups among patients having made home-visit appointments (). Moreover, the percentage of chronic sufferers increased statistically significantly in the successive surveys: 74.0%, 79.6%, and 87.2%, respectively (p<0.01).
Discussion
We found a decrease in the frequency of home visits by family physicians in the years 1998, 2002, and 2006, which may have various interpretations. First of all, during the study period, improvement was observed in the accessibility of services such as making an appointment by phone for a particular hour and obtaining medical advice on the phone Citation[4]. Medical care provided by the same family physician chosen by each patient ensures continuity of care and thus better understanding of patients’ needs. Frequent contact of the family doctor with the patient allows proper assessment of the patient's health situation, and may thus help make the right decision on the necessity of a home visit.
Moreover, changes observed in the functioning of nurses’ practices and independent service contracting have improved their accessibility Citation[5]. Regular visits of community/family nurses to chronically ill patients may be an important cause of the reduced number of home visits by family physicians.
Other causes may include patients’ education concerning the justification of home visits, and a greater number of people possessing cars and therefore able to get to the doctor's surgery.
Worthy of note is that, in the study population, the percentage of younger people making a home-visit appointment decreased, and at the same time the percentage of patients aged 65 years and above increased, confirming population aging.
The current study implies some changes in home medical care provided by family physicians in Poland. During these 8 years, “unnecessary” home visits were eliminated, while home-care services for the elderly and chronically ill patients increased. This finding indicates a growing demand for home visits in these groups of patients.
Undoubtedly, implementation of the institution of the family physician has facilitated proper usage of home visits, being one of the primary healthcare services.
Conclusion
During the 8-year observation period, a decrease was observed in the number of home visits by family physicians. At the same time, the percentage of chronically ill and elderly patients who made home-visit appointments with family physicians increased.
Acknowledgements
The current study was conducted at the Medical University of Białystok, grant no 4-04512 P.
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