TY - JOUR T1 - Integrating Physician Services in the Home JF - Canadian Family Physician JO - Can Fam Physician SP - 1166 LP - 1174 VL - 56 IS - 11 AU - Moira Stewart AU - John F. Sangster AU - Bridget L. Ryan AU - Jeffrey S. Hoch AU - Irene Cohen AU - Carol L. McWilliam AU - Joan Mitchell AU - Evelyn Vingilis AU - Christine Tyrrell AU - Ian R. McWhinney Y1 - 2010/11/01 UR - http://www.cfp.ca/content/56/11/1166.abstract N2 - OBJECTIVE To evaluate a new program, Integrating Physician Services in the Home (IPSITH), to integrate family practice and home care for acutely ill patients. DESIGN Causal model, mixed-method, multi-measures design including comparison of IPSITH and non-IPSITH patients. Data were collected through chart reviews and through surveys of IPSITH and non-IPSITH patients, caregivers, family physicians, and community nurses. SETTING London, Ont, and surrounding communities, where home care is coordinated through the Community Care Access Centre. PARTICIPANTS A total of 82 patients receiving the new IPSITH program of care (including 29 family physicians and 1 nurse practitioner), 82 non-randomized matched patients receiving usual care (and their physicians), community nurses, and caregivers. MAIN OUTCOME MEASURES Emergency department (ED) visits and satisfaction with care. Analysis included a process evaluation of the IPSITH program and an outcomes evaluation comparing IPSITH and non-IPSITH patients. RESULTS Patients and family physicians were very satisfied with the addition of a nurse practitioner to the IPSITH team. Controlling for symptom severity, a significantly smaller proportion of IPSITH patients had ED visits (3.7% versus 20.7%; P = .002), and IPSITH patients and their caregivers, family physicians, and community nurses had significantly higher levels of satisfaction (P < .05). There was no difference in caregiver burden between groups. CONCLUSION Family physicians can be integrated into acute home care when appropriately supported by a team including a nurse practitioner. This integrated team was associated with better patient and system outcomes. The gains for the health system are reduced strain on hospital EDs and more satisfied patients. ER -