Home visits. An access to care issue for the 21st century.

OBJECTIVETo review trends and current practices in delivery of medical care at home.QUALITY OF EVIDENCEA MEDLINE search from January 1989 to March 2000 yielded 65 articles. Most articles are descriptive; analytical studies are rare.MAIN MESSAGEThe number of home visits made by physicians has consistently declined in the last 30 years. The most common reasons cited are lack of efficiency, the time required, and poor reimbursement. Home visits, reserved mainly for frail elderly people and palliative patients, are seen as valuable for preventing unnecessary visits to emergency rooms and hospitalizations. Home visits are also useful for reducing caregivers' stress, monitoring chronic illnesses, and assessing need for institutionalization. Home visiting requires special skills; these must be taught to current trainees.CONCLUSIONWith the shift to more community-based care, the demand for physicians to make home visits will increase. Physicians must be adequately prepared to deliver home care and be reimbursed appropriately.