As a palliative care physician who cares for dying patients at home, I was struck by a few points in the project to integrate physician services in the home.1 One is the pivotal role of the nurse practitioner. Home care is extremely complex, and I think that without a dedicated manager such as a nurse practitioner, it is too much to ask of a busy family physician. Second, I was interested in the comments on cost; we often assume that home care is cheaper than hospital care (reduced use of acute care beds and emergency department visits), but Stewart and colleagues point out that this is not necessarily the case. I think it would be interesting to put some numbers to this, as that is likely to be the most telling argument for obtaining funding for these kinds of projects. Another point is that caregiver burden was not decreased in the group participating in the program, which is something I have noticed anecdotally. There seems to be considerable stress on caregivers of patients receiving in-home care that no amount of home visits can take away. I wonder if this is because caregivers feel that the ultimate responsibility for their loved ones’ well-being lies with them if they are at home, but not if they are in hospital.
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Reference
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