I can admit that I didn't realize the significance of home-based primary care visits until I began performing physicals in the home. In the office setting, patients can tell me how things are going but in the home I get a chance to SEE how things are going. In the home I am able to observe how my patients manage their medications and view all of their prescriptions (not just the ones they chose to bring in the office). In the home I am able to observe for fall hazards and see how my patients interact with their family members and caregivers. In the home I can look in their kitchen cabinets and provide education about the foods that are negatively affecting their glucose and blood pressure readings. Home-based visits give a greater view of the patient as a whole but unfortunately in the United States many of our most vulnerable patients do not receive these valuable visits.

Approximately 56.7 million people in the United States were living with some type of disability in 2010 (Brault, 2012). Living with a disability provides an increased barrier to adequate access for care. With the growing number of disabled and aging Americans, home-based visits were proposed as an alternative way of addressing the needs, values, and preferences of chronically ill, frail, and disabled patients (Agency for Healthcare Research and Quality, 2014). The U.S. Department of Veterans Affairs created a program to provide disabled veterans with access to home-based primary care services. The Independence at Home Demonstration is a program developed by the Centers for Medicare and Medicaid Services (CMS) and is designed to provide home-based primary care visits to targeted chronically ill beneficiaries for a 3-year period (CMS, 2014). Although the programs mentioned are now providing some with home-based primary care visits, additional home-based care models should be created to target people with disabilities, chronic illness, and those who are homebound.

Reaching disadvantaged individuals in the home could reduce rates of hospitalization, increase rates of compliance, and improve overall satisfaction with care. Additional training should be given to primary care providers regarding home visits. Clinicians are often not taught in school how to tailor an exam in the home as opposed to an in-office physical. Further research is also needed to gain insight on the effectiveness of home-based care. Recent literature is lacking articles that describe the benefits of home-based primary care. Once research deems these types of programs valuable, more insurance companies should follow in the footsteps of CMS and create their own programs to provide increased visits in the home setting.

I'm so thankful for the experiences I've had while performing physicals in the home. I truly feel I get to experience my patients as individuals and not just as people with illnesses. Patients are more likely to open up to me in the home than they do in the office setting. If more clinicians were able to experience the intimacy that home visits bring I believe we would have more providers flocking to home-based care. If our nation truly wants to overhaul our healthcare system, home-based primary care visits would be a beneficial way to serve those who have difficulty coming to us. Serving our most vulnerable population is truly the American way.

REFERENCES