Home visiting by general practitioners in England and Wales

BMJ 1996;313:207-210 (27 July)

General practice

Home visiting by general practitioners in England and Wales

Paul Aylin, medical statistician,^a F Azeem Majeed, lecturer in public health medicine,^b Derek G Cook, reader in epidemiology ^b

^a Office for National Statistics, London WC2B 6JP, ^b Department of Public Health Sciences, St George's Hospital Medical School, London SW17 0RE

Correspondence to: Dr Aylin. paul.aylin{at}ons.gov.uk.

Abstract

Objective: To use data from the fourth national survey of morbidityin general practice to investigate the association between homevisiting rates and patients' characteristics.
Design: Survey of diagnostic data on all home visits by generalpractitioners.
Setting: 60 general practices in England and Wales.
Subjects: 502 493 patients visited at home between September1991 and August 1992.
Main outcome measures: Home visiting rates per 1000 patientyears and home visiting ratios standardised for age and sex.
Results: 10.1% (139 801/1 378 510) of contacts with generalpractitioners took place in patients' homes. The average annualhome visiting rate was 299/1000 patient years. Rates showeda J shaped relation with age and were lowest in people aged16-24 years (103/1000) and highest in people aged >/=85 years(3009/1000). 1.3% of patients were visited five or more timesand received 39% of visits. Age and sex standardised home visitingratios increased from 69 (95% confidence interval 68 to 70)in social class I to 129 (128 to 130) in social class V. Thecommonest diagnostic group was diseases of the respiratory system.In older age groups, diseases of the circulatory system wasalso a common diagnostic group. Standardised home visiting ratiosfor the 60 practices in the study varied nearly eightfold, from28 to 218 (inter-quartile range 67 to 126).
Conclusions: Home visits remain an important component of generalpractitioners' workload. As well as the strong associationsbetween home visiting rates and patient characteristics, therewere also large differences between practices in home visitingrates. A small number of patients received a disproportionatelyhigh number of home visits. Further investigation of patientswith high home visiting rates may help to explain the largedifferences in workload between general practices and help inallocation of resources to practices.

Key messages

Annual home visiting rates declined by 27% between 1981-2 and 1991-2, from 411/1000 patient years to 299/1000, suggesting that general practitioners are altering the way in which they provide care to provide less care in patients' homes; however, home visits were responsible for 10% of all contacts with general practitioners
Home visiting rates showed a J shaped relation with age and, after standardisation for age and sex, were twice as high in people from social class V as in people from social class I
There was a nearly eightfold variation in age and sex standardised home visiting ratios among the 60 general practices in this study, and just over 1% of patients registered with general practitioners received nearly 40% of all home visits
Further investigation of both patients and practices with high home visiting rates may help to explain the large differences in workload among general practices and also help in the allocation of resources to practices

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