Article CommentaryCommentary

Back to the future: home-based primary care for older homebound Canadians

Part 1: where we are now

Nathan Stall, Mark Nowaczynski and Samir K. Sinha
Canadian Family Physician March 2013; 59 (3) 237-240;

Article Figures & Data

Tables

  • Table 1

    Distinguishing home-based primary care from other home-care models

    FEATUREMODEL
    HOME-BASED PRIMARY CAREOUTREACH HOME VISITSHOSPITAL-AT-HOMETRANSITIONAL HOME CARESKILLED HOME CARE
    Functional modelOngoing comprehensive primary care in the home14Home-based multidimensional geriatric assessmentsAcute medical care in the home16Medical care after hospital dischargeTargeted nursing, allied health, and social care services
    Care focusComplex and interrelated chronic disease management and social care issuesNeeds assessmentsAcute illness or chronic disease exacerbationOften disease specific (eg, heart failure17 or chronic obstructive pulmonary disease18)Remediable conditions14 and supporting independent living
    Time courseOngoingConsultation with possible limited follow-upTime-limited to the end of an acute episodeTime-limited to a designated period after dischargeTime-limited to ongoing
    PersonnelPrimary care provider–led interprofessional teamsVaried, but typically nursing and allied health professionalsGeneral practitioners, specialists, nurses, and allied health professionalsGeneral practitioners, specialists, nurses, and allied health professionalsNursing and allied health professionals only
    Goals of care

    • Improve access to primary care

    • Maximize independence and function

    • Reduce emergency department, hospital, and long-term care admissions

    • Enhance patient safety and quality of life

    • Link with supportive home-care services14,15

    • Assess needs and develop care plan (to be implemented by office-based primary care provider or specialist)

    • Serve as a substitute for acute hospital care

    • Reduce iatrogenic events (nosocomial infections, functional decline, pressure sores, delirium, falls, etc)16

    • Reduce overall costs

    • Prevent adverse outcomes after discharge from hospital (improve coordination and continuity of care, reduce readmissions)19

    • Reduce overall costs

    • Support independent living

  • Table 2

    Emerging evidence supporting HBPC

    STUDYDESIGNSAMPLE SIZE (INTERVENTION/CONTROL)SETTINGDURATIONED VISITSHOSPITAL ADMISSIONSLTC ADMISSIONS
    Beck et al, 200926Observational468/0Marion County, Indianapolis7 yDecreased 15%Decreased 8%Not measured
    Chang et al, 200828Retrospective review183/0Washington VA Medical Center2 yNo significant differenceDecreased 44%Not measured
    Cooper et al, 200729Retrospective review20 783/0All veterans in the US HBPC program1 yNot measuredDecreased 27%Not measured
    De Jonge and Taler, 200213Observational480/0Washington Hospital Center3 yNot measuredDecreased 30%Decreased 10%
    Hughes et al, 200027Multisite randomized controlled trial981/98516 US VA medical centres4 yNot measuredNo significant difference (but decreased 22% in severely disabled)Not measured
    North et al, 200815Observational104/0Denver VA Medical Center1 yDecreased 48%Decreased 84%Not measured
    Rosenberg, 201230Observational248/0Victoria, BC1 yDecreased 20%Decreased 40%Not measured
    Wajnberg et al, 20102Retrospective review179/0Bronx, NY22 moNot measuredDecreased 23%Decreased 20%

    • ED—emergency department, HBPC—home-based primary care, LTC—long-term care, VA—Veterans Affairs.

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Back to the future: home-based primary care for older homebound Canadians
Nathan Stall, Mark Nowaczynski, Samir K. Sinha
Canadian Family Physician Mar 2013, 59 (3) 237-240;
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