A New Model for Home-Based Primary Care
Home-Based Primary Care (HBPC) is a model that could help both at-home patients and their caregivers access a streamlined and integrated care model according to a study led by researchers at University of Toronto Department of Family and Community Medicine (DFCM).
“HBPC, by definition, is intended to provide primary care for homebound patients. The delivery of care is effective and efficient because it is a full team of medical professionals tending to one patient,” says Dr. Thuy-Nga Pham, Assistant Professor at DFCM and physician at the South East Toronto Family Health Team. “Team-based HBPC is comprised of an integrated team of healthcare providers: Think nurse practitioner, physician assistant, a family doctor working hand-in-hand with the home-care case manager. The findings of our research demonstrate that team-based HBPC is a suitable, effective and efficient solution to reach populations that can’t make it out to the doctor’s office any longer.” 
Six of the DFCM academic family health teams and house calls researched the impact of HBPC on families and other unpaid caregivers in their recently published qualitative study. Researchers interviewed a sample of unpaid caregivers of relatives or friends needing care. Findings from this study reinforced the need for HBPC as the population is ageing and the need for access to care is critical for homebound patients. Dr. Pham, a family doctor involved with a care team, states that this model tends to benefit the patient but more specifically, provides a bit of freedom to their caregiver.
“When I do home visits, I am always surprised to see a patient in his 90s and his spouse who is just as old as he or she is, administer insulin, make clinical decisions and even lift him or her up,” she says. “There is a real sense among caregivers that they are left alone. As a patient, you are lucky if you even have at least one person by your side, your family or friend as a caregiver. As soon as the HBPC team comes in, the patient, as well as the caregiver, feel that they have someone with whom they can troubleshoot and navigate the healthcare system with. It does not address all of the aspects of caregiver burden, but at least it helps them breathe a little easier.”
Between 75 to 90 percent of care offered by caregivers in Canada is unpaid: Family members or friends undertake the arduous task of providing nursing and clinical care to their loved ones. Others take this work on a full-time basis, again, at times, unpaid. Most do not understand all the medical complexities associated with home care.
The participants interviewed for the study described the long hours and gruelling work attached to caregiving. With HBPC, they welcomed the individualized and holistic care their loved one received which included the coordination of their multiple appointments. Moreover, they appreciated the ability of just being able to call “a person”.
“It was so much worry before I go to them (sic)– what am I gonna do? Whom am I gonna call?” says one participant in the study who expressed frustration with the previous system. “I do not know what I was to do. There’s no number to call. Whom do you contact?”
“It was not until the [HBPC team] came around that… it took that much pressure off me. It’s like, at least that’d one area I don’t have to worry about,” another participant answered.
While team-based integrated HBPC is still a relatively new concept in Ontario, nine DFCM teaching units are actively offering this model of care. There is interest mounting in providing services at home for the elderly as Canada’s older population is expected to double in the coming years. DFCM’s Drs. Pham, Akhtar and Nowaczynski state that this study points to many opportunities to expand and enhance HBPC, including teaching DFCM family medicine residents relevant competencies in HBPC.
“HBPC needs to remain an essential element of primary care moving into the future,” says Pham. “Providing home-based primary care teaches competencies in family medicine in general. At the core, training our family physicians in this realm is crucial to ensure that we do not abandon or neglect our patients as they age or become frailer.”
This study was part of the BRIDGES program, a joint initiative led by the Departments of Medicine, the DFCM at the University of Toronto, and the Ministry of Health. Its goal was to explore the systemic health services delivery challenges in Ontario’s health care system and support innovative models, testing and evaluating new solutions to improve care.