Emergency Home Visits by Family Doctors During the Day and During the Night

First Results of the SESAM-3 StudyIntroduction: Home visits are an integral part of family practitioners’ (FPs) work in providing health care to multimorbid and immobile patients in Germany. The Saxon Association for Family Medicine (SGAM) and the department of Family Practice of the Medical Faculty of Technical University of Dresden conducted the 3rd Saxon Epidemiological Study of Family Medicine (SESAM-3) in March 2009 to analyse reasons for encounter at FPs’ home visits. This study gives the first overview of the demographic and disease-specific characteristics of home visit patients (of SESAM-3) and points out the common reasons for encounter.Methods: In this cross-sectional study, 59 FPs (registered in the SGAM) documented their first 20 home visits of March 2009 using a questionnaire.Results: A total of 1896 reasons for encounter for 970 patients were documented. The majority of the patients were elderly, multimorbid people that were regularly visited at home from their FP. The proportion of women (69 %) predominated in the SESAM-3-sample. The mean age of the sample was 77.1 +/- 15.9 (s. d. ) years. Unspecific symptoms (weakness, fever, cardiovascular complaints) were the most common reasons for encounter for 47.9% of the home visit patients. 41.5 % of the home visits were planned routine visits for the care of chronic patients.Discussion: Particularly elderly and multimorbid patients utilized FPs´ home visits in the SESAM-3-sample. The reasons for encounter in home visits were predominantly based on unspecific symptoms (weakness, fever, cardiovascular complaints), indicating a large proportion of acute initiated home visits.

An Analysis of an Email Discussion Amongst Family PractitionersSummary: Which motivations are relevant in the family practitioners decision to make a home visit? An email discussion about home visits was examined by a qualitative analysis. The arguments of family doctors could be clustered in the categories self-conception/role perception; evidence; law/contracts; social expectations; phone triage; personal experience; time expenditure and others. These categories seem to determine the decision for a home visit besides the medical indication. The contributions highlight the ambivalence of family doctors regarding home visits and the respective scientific data. More evidence is urgently needed.

Background: Home visits are a classical part of family physicians tasks. They can provide additional information about the patient and his living conditions (“experienced anamnesis”) as well as about health care needs (e.g. medical equipment needed). Aim of this publication was to describe relevant aspects of performing home visits.Search method: Pragmatic search (no limit of language or publication date) with the terms “home visit“ OR “house calls“ AND “general practitioner“ AND “Germany“ in the data bank PubMed supplemented by a search in the online archive of the German Journal of Family Medicine with the term „Hausbesuch“ (home visit).Main messages: Most important aspects needed for adequate performance of home visits are medical decision making (e.g. hospital referral yes or no), organizational aspects (e.g. who decides about the urgency of the home visit) and safety (e.g. handling of animals). The equipment needed will depend on the region (city or rural remote areas) and on the individual experience of the physician. A sufficient source of light will be needed in any case.Conclusions: Home visits remain an important component of family doctors’ routine with a huge variety of aspects that needed to be thought of. Therefore planning, organization and performing of home visits should be learned in a structured way.