[Geriatric home visits can prevent hospitalisation of subacute patients but is time-consuming. A randomised study]

To study if geriatric home visits could prevent hospital admittance of geriatric patients referred subacute by general practitioners.

Patients were randomised to first contact by geriatric home visit (n=59), or to subacute admittance to a geriatric ward (n=43), median age 79.0 and 82.5 years, women 64% and 72%, Barthel-index 755 and 770 and MMSE 24,0 and 23,0. Only 30% of the total number of subacute referred patients were included.

53% (31/59) randomised to home visits were not admitted to hospital, 17% (10/59) were admitted at the first home visit and 12% (7/59) within the first 7 days. Patients admitted within the first 7 days were more often single, 84% (n=16/19) as compared to 52% (16/31) of those not admitted. The time used on home visits was on average 122 min, including 23 min (19%) for transportation. Among the 43 patients randomised to subacute admittance 16% (7/43) were sent home within 24 hours, and of these 73% were seen in the outpatient clinic, 26% (11/42) were sent home on day 2-7 and of these 27% were seen in the outpatient clinic. The overall median time in contact with the geriatric department was 27.1 days (n=59) in the home visit group and 15.0 days (n=43) in the admitted group (p<0.05). There were no significant differences in patient satisfaction or self-rated health. The average time used by the municipality for home service was reduced to 15 min/day in patients sent to hospital (p<0.01) and increased to 44 min/day in patients not admitted (p<0.05).

Hospital admittance was avoided by geriatric home visits. However, time consumption was high. The municipality costs increased for non-admitted patients. The overall time in contact with the geriatric department was shortest for admitted patients.