Filling gaps in care for housebound patients

For many housebound older patients, seeing a GP in their own home can be a real boon.
 
Every week, Melbourne GP Dr Floyd Gomes visits older patients in their own home during the day, as their regular doctor. 
 
But, from his experience, this is a rarity in Australia.
 
He believes that there is a significantly under-served population of patients who are housebound – and thus unable to get to a clinic or even have a regular GP.
 
‘My findings are that there is not an insignificant number of patients in the community who, once they are no longer able to come to a medical clinic, they really lose connection with general practice,’ Dr Gomes told newsGP.
 
‘At some point these patients cannot physically come [to a clinic] for whatever reason, usually failing health, and the bottom line is you very rarely see that patient again.
 
‘Something mysterious happens just before they end up going into a nursing home.’
To help address this gap, Dr Gomes established Mobile GP – a free, national service that also aims to increase access to a regular GP for people who are geographically isolated or living with disability.
 
The service provides administration, reception and billing – the GP receives 100% of the Medicare billing rebates for home care visits.
 
Dr Gomes also hopes that by recognising the important role GPs play in the community, Mobile GP will help bring the issue to the fore and support those GPs who want to get involved.
 
While some GPs still do home visits, Dr Gomes said they are ‘as rare as hen’s teeth’.
 
‘Part of the reason for GPs not getting to do these home visits comes down to the fact it’s hard to make viable,’ he said.
 
‘The [need] is there, but so far it’s just not viable compared to being in a clinic.’
 
Travel to a patient’s home and billing can also present as barriers. According to Dr Gomes, the average older patient ‘might struggle’ with being privately billed for a home visit.
 
In the same way there are some doctors who are willing to work in nursing homes and some who are not, Dr Gomes believes there are also some who would enjoy doing home visits if they were comparable financially to being in a clinic.
 
But this element of care is just not ‘the norm’ in Australia – which is what he wants to change.
 
‘It is rare home visits get done, and the people who do fill that gap are the after-hours locums,’ he said.
 
‘Some patients may almost have an after-hours locum as their regular GP. They regularly call them to fulfil that need ... and they may end up being a “quasi-regular” doctor.
 
‘For patients who can visit a GP, that’s great, but often there are people who can’t and they struggle – and that’s what Mobile GP is aimed at.’


Dr Floyd Gomes wants to fill gaps in the cycle of care for older patients and get GPs interested in doing regular visits for housebound patients.

Dr Gomes also acknowledges the often-longstanding nature of the relationship between a patient and their GP, which he hopes will be fostered through the service.
 
‘It’s really for the goodness [of the doctor–patient relationship] and it’s hard to have anything stable as a service based on that,’ he said.
 
‘You don’t have as much equipment as you would in a clinic, but ... the relationship you then build is a different one when you see the patient at home.
 
‘I think there is a real issue with the connection between home care services and primary health. There are distinct siloes and it does change the complexion of care.’
 
‘How do we best target the home visits that are useful and support the GPs willing to do that job?’ Dr Gomes asked.
 
‘These are the patients who we are trying to help, because their desire to stay at home is one that should be supported, and more than just in a “home care package” sense – here is a GP to help you stay at home.
 
‘As a society, if we can allow people to have their last days at home, that is really something that ties off their life.’
 
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