home-based primary care (HBPC)
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Introduction
Veterans Administration offers Home-Based Primary Care (HBPC)
Indications
- comprehensive, interdisciplinary, primary care in the homes of patients with complex medical, social & behavioral conditions for which clinic-based care is not feasible or effective
- the primary focus of HBPC is longitudinal care for complex chronic disabling disease
- HBPC is intended for frail, chronically ill patients who would benefit from a multidisciplinary approach to coordination of care & the integration of diverse services to cover complex medical, social, relabilitative, nutritional, & behavioral care needs
- goal of HBPC include
- maximizing function
- minimizing institutionalization
- maintaining quality of life
- supporting the caregiver in care of the patient
- avoiding duplication of service
- reducing total health care expenditures
- providing an academic & clinical setting for health care trainees to experience interdisciplinary delivery of primary care in the home
- patients for whom HBPC may be cost effective include:
- patients with impaired mobility, due to disability or functional limitation making it difficult to leave the home without the assistance of a device or another person
- patients with impaired ability to cope with a clinic environment due to cognitive, physical or psychiatric impairment
- patients with a need for frequent coordinated interventions from multiple disciplines
- patients with recurrent hospitalizations or urgent care visits
Contraindications
- excludes nursing home patients
Procedure
- components of successful HBPC programs[8]:
- integrated interprofessional care teams
- regular (at least weekly) interprofessional care meetings
- comprehensive geriatric assessment at intake
- after-hours urgent telephone service
Notes
- comprehensive home care by interdisciplinary teams can reduce hospital admissions & overall costs in frail elderly[6]
- regularly scheduled team meetings to discuss specific patients[7]
- nurse practitioners provide the most primary care in the home[9]
More general terms
Additional terms
References
- ↑ Veterans Administration, VA Handbook 1141.01 January 31, 2007
- ↑ Kao H, Conant R, Soriano T, McCormick W. The past, present, and future of house calls. Clin Geriatr Med. 2009 Feb;25(1):19-34 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19217490
- ↑ Landers SH, Gunn PW, Stange KC. An emerging model of primary care for older adults: the house call-home care practice. Care Manag J. 2009;10(3):110-4. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19772208
- ↑ Oldenquist GW, Scott L, Finucane TE. Home care: what a physician needs to know. Cleve Clin J Med. 2001 May;68(5):433-40. PMID: https://www.ncbi.nlm.nih.gov/pubmed/11352323
- ↑ Hirth V, Baskins J, Dever-Bumba M. Program of all-inclusive care (PACE): past, present, and future. J Am Med Dir Assoc. 2009 Mar;10(3):155-60. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19233054
- ↑ 6.0 6.1 De Jonge KE et al. Effects of home-based primary care on Medicare costs in high-risk elders. J Am Geriatr Soc 2014 Oct; 62:1825. (http://dx.doi.org/10.1111/jgs.12974) PMID: https://www.ncbi.nlm.nih.gov/pubmed/25039690
Edes T et al. Better access, quality, and cost for clinically complex veterans with home-based primary care. J Am Geriatr Soc 2014 Oct; 62:1954 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25039690 - ↑ 7.0 7.1 Leff B, Weston CM, Garrigues S et al Home-based primary care practices in the United States: current state and quality improvement approaches. J Am Geriatr Soc. 2015 May;63(5):963-9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25940131
- ↑ 8.0 8.1 Stall N, Nowaczynski M, Sinha SK. Systematic review of outcomes from home-based primary care programs for homebound older adults. J Am Geriatr Soc. 2014;62:2243-2251 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25371236
- ↑ 9.0 9.1 Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022