Exploring the safety measures by doctors on after-hours house call services

Aggression against doctors involved in after-hours house calls (AHHC) is widely perceived to be high. It is, however, unclear how doctors who perform this service manage the risk of aggressive patients during home visits.

The aim of this paper is to explore if and how doctors manage the risk of violence against them during AHHC.

A survey was designed and administered to all 300 Australian-based doctors engaged in AHHC under the National Home Doctor Service (NHDS). The survey was conducted from September 2014 to November 2014.

There were 172 responses (57.3 per cent). Only 43 per cent of respondents adopted personal protective measures. The remaining 57 per cent had none; of those 6 per cent had never considered protective measures, and 31.8 per cent were aware of the risk of violence, but were unsure of what to do. Measures adopted include the use of chaperones/security personnel (34.1 per cent), dependence on surgery policies (31.2 per cent), de-escalation techniques (15.2 per cent), panic buttons (7.2 per cent), personal alarms (6.1 per cent), and others (6.5 per cent). Females were more likely to adopt personal protective measures than males (OR 4.94; p<0.01; CI 1.70-14.34), and Australian-trained doctors were less likely to do so relative to overseas-trained doctors (OR 0.35; p=0.04; CI 0.12-0.99).

Just over half of the doctors involved in AHHC took no precautions against aggressive attacks while on duty, and nearly one-third relied on the policies of their employing surgeries.