Five “P’s” to Prove the Case for Home-Based Primary Care
Author: Dr. Paul Chiang, Senior Medical and Practice Advisor, HCCI
The heart of medicine is about service. For many of us who became medical providers, one of the key drivers in choosing this profession is the desire to care for patients. For some of us, we felt the added call to care for the chronically ill, frail, and those who lack access to regular medical care.
Over the past 22 years, I have made over 35,000 house calls, and I serve as the Home Centered Care Institute’s Senior Medical and Practice Advisor. I’m excited to share some insights from my years of travel here on the HCCI Blog. In this post, I will discuss what I call “The Five P’s of Home-Based Primary Care (HBPC)” and why care at home is an amazing place for clinicians to practice and the preferred place for chronically ill patients to receive care.
Patients and family members prefer care at home because it eases the burden and logistics related to traveling to see a provider. This is especially important for patients with chronic heart or lung illnesses, visual impairment, difficulty with ambulation, or neuro-degenerative disorders.
Medical care at home also reduces the caregiver burden by eliminating the logistics involved in transporting their loved ones to and from their home to the office. Caregivers no longer need to worry about traffic, weather conditions, parking, or taking additional time off from work.
Nowhere else in medicine can I get a better sense of the day-to-day activities and struggles of my patient than during a home visit. I get a glimpse into my patient’s life every time I step through the front door of the home. Depending on the patient, I learn about their children, grandchildren, war experiences, professional accomplishments, hobbies, faith, favorite sports teams, and more.
During the visit, I often ask my patient or the caregiver to physically walk me through a typical day for the patient. Where does the patient sleep? How does the patient get to the bathroom? How does he get in and out of the shower? How does she get from the bathroom to the kitchen? What challenges does the patient face in getting around his home? What kinds of food does she eat? With their permission, I then look in the fridge and cupboards to confirm.
Delivering care at home reminds me that my patient is a person with hopes, fears, joys, and sorrows who wants to be understood and cared for in a personal way, and not just a patient with a long list of medical problems.
Many of us went into medicine because we enjoy thinking and problem-solving. House call providers often take care of their complex patients alone without the support of a specialist. The provider needs to have a deep working knowledge of complex medical conditions to provide outstanding and comprehensive care. The patient’s care plan needs to be filtered through the HBPC “lens,” taking into consideration the patient’s medical, psychosocial, emotional, and environmental conditions to provide optimal solutions to difficult scenarios.
Practical and Plausible Medical Care Plan
When I create a care plan for my patient, I must consider if the patient and/or their family members have an adequate social structure in place to carry out and sustain my recommendations. Are there any financial or transportation barriers in obtaining the recommended interventions? I can write a prescription for my patient, but if no one can pick up that prescription, then I must come up with an alternative plan. What is the physical environment of the patient’s home? I can order a device that can assist in patient transfer, but if the dimensions of the patient’s room cannot accommodate that device, then I will need to come up with a different recommendation.
Several studies have examined the financial benefit of incorporating HBPC into the treatment of patients who are chronically ill, frail, and multi-complex. In reviewing these studies, I believe that, compared to the traditional medical care of these patients, HBPC delivers high-quality, patient-centered care at a lower cost. This is especially important as our society is facing a large increase in the elderly population, and payers are looking for opportunities to provide quality medical care while controlling medical costs.
House call medicine provides me a great opportunity to care for my patients who have difficulty accessing regular medical care. I greatly enjoy the personal interactions and relationships I develop with my patients and their families. In all, I love what I do.