Physician House Calls: An Old Model With a Modern-Day Twist

A physician who makes house calls often evokes a quaint stereotype of a kindly, experienced doctor, carrying a black bag when knocking on the doors of the infirm. In the 1930s, physician house calls represented 40% of physician-patient encounters.¹ By the late 20th century, this model largely became obsolete, pushed aside by office-centered medicine and mega health systems. In 1972, only about 5% of care provided by general practitioners took place in patients’ homes, and by 1980, house calls had decreased even further, to less than 1%.²

Today, physician house calls are staging a comeback, driven by the need to address barriers in healthcare access, including cost and availability of timely care.² Long wait times for appointments with a primary care physician and increasing use of costly emergency department (ED) visits have led to the reemergence of house calls as an alternative care delivery model.²

Evolving habits of consumers who use smartphone apps and on-demand services have led to the growth of on-demand, app-based physician house calls as a viable alternative to office- or ED-based visits or more traditional models of home-based services.²

To shed light on this emerging phenomenon, MPR interviewed three experts: Shannon Fortin Ensign, MD, PhD, Chief Resident, Internal Medicine, Scripps Clinic/Scripps Green Hospital and KL2 Clinician Researcher, The Scripps Research Institute, La Jolla, CA, who is the coauthor of a recent review of on-demand app-based physician house calls;² Justin Zaghi, MD, MBA, Medical Director of Heal; and Janet O’Brien, MD, MSPH, an internist on staff at Heal.

Dr Fortin Ensign

Can you please describe your study?

It consisted of a retrospective observational analysis of data collected from Heal, a practice that is based on physician house calls, regarding home visits to 13,849 patients over a 1-year period (from August 2016 to July 2017). We assessed wait times, visit time, diagnoses, outcomes, and patient satisfaction.

What motivated your study?

The Scripps Translational Science Institute has a strong interest in learning how new technologies can be applied within the field of individualized digital medicine, and their role to impact overall healthcare. We became aware of this mobile-based platform as a way of possibly meeting the increasing demand for primary care in the community and we wanted to see how well it was working, whether individuals were actually taking advantage of the platform, and what the initial data are about how it’s being used and received.

What were some of your salient findings?

We found a bimodal age distribution in the patient population utilizing this service, peaking at 1 year and at 39 years – meaning that the app was being used most in pediatrics and among young adults. Of these, close to 94% of pediatric and 67% of adult requests were for fever and/or acute upper respiratory infection.  The mean wait time for as-soon-as-possible house calls was approximately an hour and a half, and the mean duration of each visit was close to half an hour – 27.1 minutes, to be exact.

These represent very important improvements over the time involved in a typical ambulatory care medical visit, which includes time for travel to the clinic and wait time to see the doctor.

Why did patients choose a house call over other forms of delivery, such as Urgent Care or a doctor’s office?

Most (about 70%) reported doing so for the sake of convenience or – in the case of another approximately 34% – the ability to more rapidly receive services.

What do you think accounts for the age distribution? 

The young adult population is very tech-savvy. They are accustomed to using apps and quickly scheduling appointments with a few clicks. They are also very busy working and caring for young children, so a model that doesn’t require them to leave their homes when they have a sick child is very appealing.

Were patients happy with the house call model?

There were high levels of patient satisfaction, with almost all respondents (94.2%) reporting that they would schedule house calls again. People were happy with “ASAP” visits that were not based in Urgent Care.

What advice to you have for physicians, based on your findings?

I definitely advise physicians to consider this type of model. PCPs in particular should consider all their options. There is much that they can do other than office-based work, which some report as being draining or contributing to burnout. House calls should be one job option that’s worth looking at.

Dr Zaghi

What is Heal?

Heal is a medical practice that provides house calls. We also visit patients at work, or even in their hotel rooms if they are traveling. We use innovative technology and regard ourselves as re-humanizing the practice of medicine by making healthcare more personal and convenient.

How did the company get started?

Dr Renee Dua and her husband, Nick Desai, co-founded the company in 2014 after their child got ill and required a 7 hour wait in the ED. The child got better, but Dr Dua and Nick were frustrated that they had to wait so long. While going home, they thought “there has to be a better solution” and came up with the idea of having the doctor visit the patient.

This article originally appeared on MPR