Home visits by general practitioners, which have steadily declined in number since the 1980s, are likely to increase in the future, doctors have said.
Writing in the current issue of Forum - The Journal of the Irish College of General Practitioners, Cork GPs Dr Breffini Hannon and Dr Caoilinn Monks said the health needs of older people in the community may lead to a reversal of home visiting rates.
"The increased emphasis currently being placed on providing more healthcare in the community, especially for the elderly who rely most heavily on home visits, would suggest that more home visits will be required in the future," they said.
In order to assess home visiting rates and to record GPs' attitudes towards house calls, the doctors surveyed two group practices in Co Cork serving a mixed urban-rural patient population. GPs working in the practices were asked to record details of all home visits carried out over a six-week period in 2005.
They found that just over one in 10 doctor-patient contacts were home visits. Almost 90 per cent of patients requiring home calls had medical cards, while 73 per cent of calls were to people aged 70 years and over. Some six out of 10 calls were to female patients, with 80 per cent of the home visits requested between 8am and 6pm. Just 1 per cent of house calls were to children younger than five. Some 3 per cent of house calls recorded by the researchers were to patients who were terminally ill. GPs initiated calls themselves in 8 per cent of cases.
Following the completion of each call, GPs were asked to say whether they felt it was an appropriate home visit. In 79 per cent of cases, the GP felt that a home visit was justified, including for social reasons such as a lack of patient transport.
However, the respondents said that in one in five cases, the house call would have been better dealt with in the surgery. Patients or their families were not asked for their opinion on the necessity for a home visit.
However, when calls requested out of normal surgery hours were analysed separately, just 16 per cent were rated by GPs as inappropriate.
The most common diagnosis made during house calls was respiratory problems, followed by musculoskeletal and gastroentestinal complaints. Some 10 per cent of those visited were referred to hospital for further evaluation and treatment.
According to the researchers, common themes to emerge from interviews with the GPs were: the time-consuming nature of home visits; the increased awareness of social issues afforded by house calls; the role of home visits in the provision of adequate palliative care to patients; and that two-thirds of GPs admitted to "not enjoying house visits".
At present, GPs in the Republic are remunerated on a capitation system for their medical card patients, ie a payment which is made regardless of the number of consultations. Based on age, gender and distance from the main practice, payments range from €37.65 to €178.19 per annum. The rate increases to €470.64 for first-time medical card holders over the age of 70. And there is a once-off payment of €177 for a patient requiring terminal care.
However, an additional payment is given for house calls made outside normal surgery hours.
"If the current number of home visits is to be maintained or increased, the funding provision for home visits and for caring for the terminally ill should be revised," the authors conclude.
• Do you think doctors should do more house calls? Or do you feel home visits are a thing of the past and should be discouraged? Send your comments to: healthsupplement@irish-times.ie