Demographics of a University Based Geratric Medicine House Call Program

Abstract

There has been a steady decline in the frequency of house calls by physicians during the 20th century. The reasons most commonly given for not making house calls are time constraints and poor reimbursements for the amount of time spent (1). Unlike younger age groups, those 65 and older tend to have physical limitations that prohibit routine visits to clinics (2). In a university based geriatric practice, there is a subgroup of individuals who are unable to access health care or see a physician without considerable expense and effort via ambulance transportation services. Without a physician house call visit, these older adults would not have routine access to health care (3). The Gerontology Assessment and Planning Program (GAP) at the University of North Texas Health Science Center at Fort Worth (UNTHSC) is involved in providing a physician directed house call program. By 2030, it is estimated that the older adults will comprise 25% of the total population (4). Encouraging independent living supported by community-based services will result in a greater number of homebound older adults requiring house calls by physicians (5). The challenge is to determine those likely to require house call services and the medical conditions and physical disabilities leading to the need for in home services. To understand the conditions and needs of these geriatric patients, a retrospective chart review was conducted. The study reviewed the demographic characteristics of the patients seen through the house call program, prevalent sources of referrals, health assessment at the point of admission into the house call program, profile of primary care givers and factors in the decision making process that physicians used to place patients on the service. Outcome data are presented including hospital admissions and deaths while on the house call program.