Skip to main content
NCBI home page
Canadian Family Physician logoLink to Canadian Family Physician
. 2001 Dec;47:2502–2509.

Work in progress. Integrating physicians' services in the home.

C L McWilliam 1, M Stewart 1, J Sangster 1, I Cohen 1, J Mitchell 1, C Sutherland 1, B Ryan 1
PMCID: PMC2018482  PMID: 11785281

Abstract

OBJECTIVE: While increasing acuity levels and the concomitant complexity of service demand that physicians be involved in in-home care, conflicting evidence and opinions do not show how this can best be achieved. DESIGN: A phenomenologic research design was used to obtain insights into the challenges and opportunities of integrating physicians' services into the usual in-home services in London, Ont. SETTING: Home care in London, Ont. PARTICIPANTS: Twelve participants included three patients, two family caregivers, two family physicians, the program's nurse practitioner, two case managers, and two community nurses. METHOD: In-depth interviews with a maximally varied purposeful sample of patients, caregivers, and providers were analyzed using immersion and crystallization techniques. MAIN FINDINGS: Findings revealed the potential for enhanced continuity of care and interdisciplinary team functioning. Having a nurse practitioner, interdisciplinary team-building exercises and meetings, regular face-to-face contact among all providers, support for family caregivers, and 24-hour coverage for physicians were found to be essential for success. CONCLUSION: Integration of services takes time, money, and sustained commitment, particularly when undertaken in geographically isolated communities. Informed choice and a fair remuneration system remain important considerations for family physicians.

Full Text

The Full Text of this article is available as a PDF (253.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bender A. D., Geoghegan S. S., Krasnick C. J. Planning and teamwork: critical health delivery issues. Med Group Manage J. 1990 Jul-Aug;37(4):30-2, 35. [PubMed] [Google Scholar]
  2. Bergeron R., Laberge A., Vézina L., Aubin M. Which physicians make home visits and why? A survey. CMAJ. 1999 Aug 24;161(4):369–373. [PMC free article] [PubMed] [Google Scholar]
  3. Bernstein L. H. An update on home intravenous antibiotic therapy. Geriatrics. 1991 Jun;46(6):47–54. [PubMed] [Google Scholar]
  4. Bosworth D. G., Nielson D. W. Effectiveness of home versus hospital care in the routine treatment of cystic fibrosis. Pediatr Pulmonol. 1997 Jul;24(1):42–47. doi: 10.1002/(sici)1099-0496(199707)24:1<42::aid-ppul7>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
  5. Bream T., Schapiro A. Nurse-physician networks: a focus for retention. Nurs Manage. 1989 May;20(5):74, 76-7. [PubMed] [Google Scholar]
  6. Caplan G. A., Ward J. A., Brennan N. J., Coconis J., Board N., Brown A. Hospital in the home: a randomised controlled trial. Med J Aust. 1999 Feb 15;170(4):156–160. [PubMed] [Google Scholar]
  7. Coast J., Richards S. H., Peters T. J., Gunnell D. J., Darlow M. A., Pounsford J. Hospital at home or acute hospital care? A cost minimisation analysis. BMJ. 1998 Jun 13;316(7147):1802–1806. doi: 10.1136/bmj.316.7147.1802. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Coley C. M., Li Y. H., Medsger A. R., Marrie T. J., Fine M. J., Kapoor W. N., Lave J. R., Detsky A. S., Weinstein M. C., Singer D. E. Preferences for home vs hospital care among low-risk patients with community-acquired pneumonia. Arch Intern Med. 1996 Jul 22;156(14):1565–1571. [PubMed] [Google Scholar]
  9. Coyte P. C., Young W. Regional variations in the use of home care services in Ontario, 1993/95. CMAJ. 1999 Aug 24;161(4):376–380. [PMC free article] [PubMed] [Google Scholar]
  10. Grayson M. L. Hospital-in-the-home care: is it worth the hassle? Med J Aust. 1998 Mar 16;168(6):262–263. doi: 10.5694/j.1326-5377.1998.tb140157.x. [DOI] [PubMed] [Google Scholar]
  11. Gundersen L. There's no place like home: the home health care alternative. Ann Intern Med. 1999 Oct 19;131(8):639–640. doi: 10.7326/0003-4819-131-8-199910190-00103. [DOI] [PubMed] [Google Scholar]
  12. Helmer F. T., McKnight P. Management strategies to minimize nursing turnover. Health Care Manage Rev. 1989 Winter;14(1):73–80. [PubMed] [Google Scholar]
  13. Hensher M., Fulop N., Coast J., Jefferys E. The hospital of the future. Better out than in? Alternatives to acute hospital care. BMJ. 1999 Oct 23;319(7217):1127–1130. doi: 10.1136/bmj.319.7217.1127. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Hensher M., Fulop N., Hood S., Ujah S. Does hospital-at-home make economic sense? Early discharge versus standard care for orthopaedic patients. J R Soc Med. 1996 Oct;89(10):548–551. doi: 10.1177/014107689608901003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Hood S., Parsons S., Fulop N. J. Shifting care: GP opinions of hospital at home. Br J Gen Pract. 1999 Mar;49(440):221–222. [PMC free article] [PubMed] [Google Scholar]
  16. Horak B. J., Guarino J. H., Knight C. C., Kweder S. L. Building a team on a medical floor. Health Care Manage Rev. 1991 Spring;16(2):65–71. doi: 10.1097/00004010-199101620-00011. [DOI] [PubMed] [Google Scholar]
  17. Jones J., Wilson A., Parker H., Wynn A., Jagger C., Spiers N., Parker G. Economic evaluation of hospital at home versus hospital care: cost minimisation analysis of data from randomised controlled trial. BMJ. 1999 Dec 11;319(7224):1547–1550. doi: 10.1136/bmj.319.7224.1547. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Keenan J. M., Boling P. E., Schwartzberg J. G., Olson L., Schneiderman M., McCaffrey D. J., Ripsin C. M. A national survey of the home visiting practice and attitudes of family physicians and internists. Arch Intern Med. 1992 Oct;152(10):2025–2032. [PubMed] [Google Scholar]
  19. Knaus W. A., Draper E. A., Wagner D. P., Zimmerman J. E. An evaluation of outcome from intensive care in major medical centers. Ann Intern Med. 1986 Mar;104(3):410–418. doi: 10.7326/0003-4819-104-3-410. [DOI] [PubMed] [Google Scholar]
  20. Knowelden J., Westlake L., Wright K. G., Clarke S. J. Peterborough Hospital at Home: an evaluation. J Public Health Med. 1991 Aug;13(3):182–188. doi: 10.1093/oxfordjournals.pubmed.a042616. [DOI] [PubMed] [Google Scholar]
  21. Koopman M. M., Prandoni P., Piovella F., Ockelford P. A., Brandjes D. P., van der Meer J., Gallus A. S., Simonneau G., Chesterman C. H., Prins M. H. Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home. The Tasman Study Group. N Engl J Med. 1996 Mar 14;334(11):682–687. doi: 10.1056/NEJM199603143341102. [DOI] [PubMed] [Google Scholar]
  22. Leff B., Burton L., Guido S., Greenough W. B., Steinwachs D., Burton J. R. Home hospital program: a pilot study. J Am Geriatr Soc. 1999 Jun;47(6):697–702. doi: 10.1111/j.1532-5415.1999.tb01592.x. [DOI] [PubMed] [Google Scholar]
  23. Lengacher C. A., Mabe P. R., VanCott M. L., Heinemann D., Kent K. Team-building process in launching a practice model. Nursingconnections. 1995 Summer;8(2):51–59. [PubMed] [Google Scholar]
  24. Long S. Primary health care team workshop: team members' perspectives. J Adv Nurs. 1996 May;23(5):935–941. doi: 10.1046/j.1365-2648.1996.10911.x. [DOI] [PubMed] [Google Scholar]
  25. McWhinney I. R. Fourth annual Nicholas J. Pisacano Lecture. The doctor, the patient, and the home: returning to our roots. J Am Board Fam Pract. 1997 Nov-Dec;10(6):430–435. [PubMed] [Google Scholar]
  26. McWilliam C. L., Sangster J. F. Managing patient discharge to home: the challenges of achieving quality of care. Int J Qual Health Care. 1994 Jun;6(2):147–161. doi: 10.1093/intqhc/6.2.147. [DOI] [PubMed] [Google Scholar]
  27. Montalto M., Dunt D. Delivery of traditional hospital services to patients at home. Med J Aust. 1993 Aug 16;159(4):263–265. doi: 10.5694/j.1326-5377.1993.tb137831.x. [DOI] [PubMed] [Google Scholar]
  28. Montalto M., Dunt D. Home and hospital intravenous therapy for two acute infections: an early study. Aust N Z J Med. 1997 Feb;27(1):19–23. doi: 10.1111/j.1445-5994.1997.tb00908.x. [DOI] [PubMed] [Google Scholar]
  29. Montalto M. Hospital in the home units. Early issues for GP involvement. Aust Fam Physician. 1995 May;24(5):797–801. [PubMed] [Google Scholar]
  30. Montalto M. How safe is hospital-in-the-home care? Med J Aust. 1998 Mar 16;168(6):277–280. doi: 10.5694/j.1326-5377.1998.tb140161.x. [DOI] [PubMed] [Google Scholar]
  31. O'Cathain A. Evaluation of a Hospital at Home scheme for the early discharge of patients with fractured neck of femur. J Public Health Med. 1994 Jun;16(2):205–210. doi: 10.1093/oxfordjournals.pubmed.a042958. [DOI] [PubMed] [Google Scholar]
  32. Poulton B. C., West M. A. Effective multidisciplinary teamwork in primary health care. J Adv Nurs. 1993 Jun;18(6):918–925. doi: 10.1046/j.1365-2648.1993.18060918.x. [DOI] [PubMed] [Google Scholar]
  33. Richards S. H., Coast J., Gunnell D. J., Peters T. J., Pounsford J., Darlow M. A. Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care. BMJ. 1998 Jun 13;316(7147):1796–1801. doi: 10.1136/bmj.316.7147.1796. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Ritchie B., Rendalls S., Kennedy P., Ovadia C., Mira M., Abraham K. Hospital in the Home project: Royal Prince Alfred Hospital. Aust Health Rev. 1994;17(3):96–101. [PubMed] [Google Scholar]
  35. Shepperd S., Harwood D., Gray A., Vessey M., Morgan P. Randomised controlled trial comparing hospital at home care with inpatient hospital care. II: cost minimisation analysis. BMJ. 1998 Jun 13;316(7147):1791–1796. doi: 10.1136/bmj.316.7147.1791. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Shepperd S., Harwood D., Jenkinson C., Gray A., Vessey M., Morgan P. Randomised controlled trial comparing hospital at home care with inpatient hospital care. I: three month follow up of health outcomes. BMJ. 1998 Jun 13;316(7147):1786–1791. doi: 10.1136/bmj.316.7147.1786. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Soderstrom L., Tousignant P., Kaufman T. The health and cost effects of substituting home care for inpatient acute care: a review of the evidence. CMAJ. 1999 Apr 20;160(8):1151–1155. [PMC free article] [PubMed] [Google Scholar]
  38. Stessman J., Ginsberg G., Hammerman-Rozenberg R., Friedman R., Ronen D., Israeli A., Cohen A. Decreased hospital utilization by older adults attributable to a home hospitalization program. J Am Geriatr Soc. 1996 May;44(5):591–598. doi: 10.1111/j.1532-5415.1996.tb01449.x. [DOI] [PubMed] [Google Scholar]
  39. Wilson A., Parker H., Wynn A., Jagger C., Spiers N., Jones J., Parker G. Randomised controlled trial of effectiveness of Leicester hospital at home scheme compared with hospital care. BMJ. 1999 Dec 11;319(7224):1542–1546. doi: 10.1136/bmj.319.7224.1542. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Canadian Family Physician are provided here courtesy of College of Family Physicians of Canada

RESOURCES