Home-based primary care can reduce hospital and long-term care admissions, and days in care, and improve quality of life and satisfaction with care

Stall N, Nowaczynski M, Sinha SK  Systematic review of outcomes from home-based primary care programs for homebound older adults  Journal of the American Geriatric Society. 2014;62(12):2243-51.

Review question

Do home-based primary care programs lead to positive health outcomes among home-bound older adults, their caregivers and the healthcare system more broadly?

Background

Home-bound older adults have complex and often interrelated medical and social problems that can leave them frail and marginalized.

Office-based primary care isn’t always the best way for home-bound older adults with multiple complex health conditions to access care. Compromised access can result in emergency department visits and hospitalization.

Home-based primary care, which involves primary care delivered in the home by the person’s ongoing primary care provider, is a promising alternative.

How the review was done

A detailed search of a number of electronic databases for all years up to and including March 2014,was conducted and studies that focused on home-based primary care and its influence on number of hospitalizations, days in hospital care, emergency department visits and days in long-term care beds, were included.

A total of 357 studies were identified in searches, and nine were included in the review after assessments for eligibility.

The authors did not acknowledge any funding sources for this review.

What the researchers found

Most of the home-based primary care studies included in the review found that such care reduced at least one of the following outcomes among home-bound older adults: emergency department visits, hospitalizations, days in hospital care, long-term care admissions and days in long-term care.

The review also found that home-based primary care also positively affected patient and caregiver quality of life, satisfaction with care, engagement in end-of-life decisions, and screening and vaccination rates.

At the system level, home-based primary care may also result in cost savings, although more research is needed to confirm this.  

Conclusion

This review found that specifically designed home-based primary care for home-bound older adults can reduce hospital and long-term care admissions, and overall days spent in institutional care, while improving patient and caregiver quality of life and satisfaction of care. More evidence is needed to confirm possible financial benefits of this model of care.