House Calls for Geriatric Patients Increase Among Nurse Practitioners

As the demand for house calls in the geriatric patient population grows, an increasing number of nurse practitioners (NPs) have stepped up to provide these home visits, according to a study published in theJournal of the American Geriatrics Society.

In 2013, NPs provided more than 1.13 million home visits compared with the 1.08 million made by internal medicine physicians, according to a University of Virginia Health System press release.

This is a significant jump from 1.08 million visits made by internal medicine physicians, and fewer than 925,000 NPs in 2012.

“This has implications for both house-call providers and nursing education,” said investigator Nengliang “Aaron” Yao, PhD, of the University of Virginia School of Medicine, department of Public Health Sciences. “If we want to take care of our geriatric population, we really need more providers to do so.”

Each year, the number of new physicians who get licensed is capped by the number of available medical residencies—–a limit that doesn’t affect NPs. However, many states have regulations that hinder the growth of the NP profession.

Yao believes that by revisiting these regulations, state governments could help address some of their residents’ unmet medical needs, according to the release.

“If we want to improve geriatric care and reduce rural disparities, that’s where we should go,” Yao said.

Additionally, Yao recommends that nursing schools offer training programs in home-based primary and palliative care.

For the study, investigators reviewed Medicare data to determine how many house calls were made in 2012 and 2013, who made them, and where they took place. The results of the study showed that that total number of home visits made by all specialties increased from 4.9 million to almost 5.2 million.

NPs were found to provide care over the largest geographic area, with the majority of NPs having made more than 1000 house calls in 2013 in the eastern half of the United States, with the greatest concentration in the Northeast, according to the release.

Nursing home residents were much more likely to receive house calls compared with homebound individuals who resided in their own homes.

“One wonders if this apparent disparity is connected to the financial model that supports medical care of these populations and the comparative efficiency and convenience of seeing many patients in one building,” the authors wrote. “To some extent, relative lack of services in the Midwest and West may be related to population density, though even in Western locations with high population density there is a relative lack of billed Medicare activity, which is not explained but bears further study.”