Methods: A simple analysis of cases seen from the period of inception of a nurse practitioner house call practice for a total of nine months in 2014. Data obtained using the electronic health record (EHR) used by the practice. The practice grew from 20 patients at the start of the practice in February 2014 to 226 patients by end of November 2014 (a 90% increase over a period of 9 months). In addition, included in the data collection are diagnoses of dementia, hypertension, diabetes, hyperlipidemia, and kidney disease and the service occurred in the counties of Sacramento and Placer in Northern California.
Results: Dementia constitutes the highest share in the distribution of diagnoses at 62% of cases. Co-morbidities according to highest distribution following dementia includes Hypertension 29%, Diabetes 22%, Hyperlipidemia 15% and Kidney Disease 7%.
Conclusion: Previous studies found that physicians doing house calls has decreased in number over the years. However, thee is a resurgence of house calls services by a combination of physicians (this includes concierge type practice) and those emerging practices by nurse practitioners. House calls has been a part of the American medical culture, back to the birth of modern medicine.
The distribution of cases in this study suggests that further studies are warranted and that Dementia with presenting co-morbidities presents a great challenge as far as the medical management of such co-morbid conditions and also as far as the challenges the care of these seniors present to the caregivers. House calls by a medical provider opens up opportunities to address some of the challenges that dementia and co-morbidities present, including, but not limited to, medication management, symptom management, and others.
The study limitation is that it looks at the first year of a nurse practitioner private practice in the area where the nurse practitioner has set up practice. We cannot make generalized statements about physician's or nurse practitioner’s practice patterns. We captured only house calls made by the Nurse practitioner in this practice.
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