House call: More than half of all home visits in Ontario are made by a small subset of family physicians
The top 5% of home visit physicians—330 family doctors in Ontario—provided more than half of all family physician home visits in 2019, according to a new study.
The research, led by University Health Network (UHN) and ICES, also found that patients of high-volume home visit physicians are younger, use more healthcare resources, are more likely to be recent immigrants, and live in lower-income and large urban neighbourhoods.
Although physician home visits could have improved access to primary care for those without a family physician, including recent immigrants, most patients (median of 73%) were already enrolled to another family physician. Seeing an unrelated physician in their home may improve patients’ access, but can reduce continuity of care—a vital component of high-quality primary care.
“Home-based primary care can fill an important gap for patients who have difficulty leaving the house for appointments, or who wish to receive end-of-life care at home. As Ontarians age, the home-visiting workforce will be essential to ensuring access to high-quality primary care for all,” says senior author Lauren Lapointe-Shaw, adjunct scientist with ICES, general internal medicine physician, scientist at UHN, and Innovation Fellow at the Women’s College Hospital Institute for Health System Solutions and Virtual Care.
Published in CMAJ Open, the study used health administrative data of Ontario family physicians who had at least one home visit in 2019. Physician demographics, practice patterns, and patient characteristics were compared between physicians who provided the most home visits to patients (categorized as high-volume; in the top 5%) and physicians who provided the fewest home visits (categorized as low-volume; in the bottom 95%).
The data showed that:
- The top 5% of home visit physicians (a total of 330) performed 59% of all home visits.
- 88% of home visits performed by low-volume physicians were to patients already enrolled with them, compared to only 4% of those provided by high-volume physicians.
- Overall, 85% of low-volume home visit physicians were part of an enrolling medical home, which suggests that financial incentives are working to encourage physicians to provide home visits to their enrolled patients.
- However, the highest volume physicians were less likely to be part of an enrolling medical home (65 vs 85%) and more likely to practice in a fee-for-service model (36% compared to 15%)
- Compared to low-volume home visit physicians (a total of 6,242), the top 5% were more likely to be male and practice in large urban areas, and a lower percentage of them belonged to a team-based medical practice.
One limitation of the study is that the data doesn’t provide details about why so few physicians see a high volume of patients at home. The researchers also could not examine the quality of home visits or assess patient preferences for home versus office-based primary care. Further research is also needed to explore the growth of virtual care following the COVID-19 pandemic, and the resulting change in practice patterns.
The researchers say that additional qualitative research is also needed to understand the reasons why Ontario doctors choose to provide home visits.
“Prioritizing ageing at home includes supporting home-based primary care, and ensuring this is part of an ongoing care relationship,” says senior author Dr. Lauren Lapointe-Shaw. "We need to know what motivates physicians to visit patients at home, and ideally, there should be better integration of home visit delivery and comprehensive primary care.”
The study, “Characteristics and practice patterns of family physicians who provide home visits in Ontario, Canada: a cross-sectional study” was published in CMAJ Open.
Author block: Salahub C, Kiran T, Na Y, Sinha SK, Stall NM, Ivers NM, Costa AP, Jones A, Lapointe-Shaw L.
ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario
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University Health Network consists of Toronto General and Toronto Western Hospitals, the Princess Margaret Cancer Centre, Toronto Rehabilitation Institute, and The Michener Institute of Education at UHN. The scope of research and complexity of cases at University Health Network has made it a national and international source for discovery, education and patient care. It has the largest hospital-based research program in Canada, with major research in cardiology, transplantation, neurosciences, oncology, surgical innovation, arthritis, vision, infectious diseases, genomic medicine and rehabilitation medicine. University Health Network is a research hospital affiliated with the University of Toronto. For more information: www.uhn.ca
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