Home Visit

Question 1

Definition of Home Visit

Answer 1

A service made by the HCP to a patients home which allows the HCP to access the home and family situations in order to provide the necessary health related care.

Question 2

Eg of a specific home based intervention

Answer 2

Adjusting the elderly pts home environment to prevent falls

Question 3

Types of Home Visits

Answer 3

Illness visits
Visits to dying pt and their families
Assessment visits
Hospitalization follow-up or monitoring visit

Question 4

Illness home visits involes

Answer 4

Emergency
Acute illness
Chronic illness
With home health agencies

Question 5

Dying pt home visits involves?

Answer 5

Terminal care with hospice agency
Pronouncement of death
Grief support (med, psychosocial,env, & financial resources)

Question 6

Need for assessment home visits involves

Answer 6

Role of home environment in pt health status
Polypharmacy
Multiple medical problems
Excessive use healthcare services
Immobility
Social isolation
Suspected abuse or neglect
Recent catastrophic diagnoses
Possible need for nursing home placement

Question 7

Hospitalization follow up home visits involves

Answer 7

When significant life changes have occurred.
Acute illness
Injury or surgery
Parents with newborn infants

Question 8

Planning how to conduct the home visit

Answer 8

Clarify the reason for the visit and carefully plan the agenda.
Gathering the necessary equipment
Patient education materials
Having a map
Pt telephone number
Directions to the pt home
Set formal appointment time for the visit
Presence of key family members or significant others
Confirming the appointment time

Question 9

Essential Equipment for Home visit

Answer 9

Lubricant
Diagnostic set
Patients record and charting materials
Prescription pad
Sphygmomanometer
Stethoscope
Sterile specimen cups
Stool guaiac cards
Thermometer
Urine dipsticks

Question 10

Optional Equipment for Home Visit

Answer 10

Glucometer
Laptop Computer
Patient education materials

Question 11

Patient-supplied equipment

Answer 11

Glucometer
Peak flow meter
Scale

Question 12

Issues to assess during Home Visit/ Elements of Home Visit

Answer 12

I - Immobility
N -Nutrition
H -Housing
O- Other People
M -Medications
E- Examinations
S -Safety
S -Spiritual Health
S -Services by home health agencies

These may be used independently, based on the needs of the patient and the physician’s agenda.

Question 13

Immobility

Answer 13

Patients functional activities
Activities of daily living
Instrumental activities of daily living
Corrective intervention

Question 14

Nutrition

Answer 14

Assess the current state of nutrition
Eating behavior
Food preferences

Look at the fridge
Check product labels
Review food preparation techniques

Question 15

Home Environment

Answer 15

Privacy, social interaction, spiritual and emotional comfort and safety.
Close proximity to services
Reflect pride in fam, hobbies and interest
Do not make assumptions of wealth based on home env

Question 16

Other people

Answer 16

Assess the pt support group
Availability of emergency help
Surrogate for pt in the event of incapacitation
Durable power of attorney
Living will
Caregiver need and risk of burnout

Question 17

Medication

Answer 17

Polypharmacy
Type amount and frequency of drug
Drug-drug/ Drug-food interaction
Pt compliance
Doctor shopping
Home remedies
Use and abuse of OTC

Question 18

Examination

Answer 18

Physical Exam based on the need of pt and Dr. agenda.
Practical function related Exam like getting up from bed, use of bathtub.
Self-monitoring of sugar level and BP
Anthropometry

Question 19

Safety

Answer 19

Areas to assess include?
Kitchen safety esp use of gas
Bathroom safety
Stairs
Gas or electrical utilities
Hot water source
Heating and air conditioner
Emergency action and evacuation
Smoke dictators and fire extinguishers
Electrical cords
Lighting and night lights
Pets
Loose carpet and throw rugs
Table chairs and other furniture

Question 20

Spiritual Health

Answer 20

Influence of Spiritual belief on pt sense of physical or emotional health
Spirituality as a coping and healing strategy

Question 21

Services

Answer 21

Assess relationship with the home health agency
Existing orders, future cares and other perspective of care plan

Question 22

Example of Targeted Home Visit Assessment

Answer 22

polypharmacy and safety in a patient with a recent fall, or to assess mobility and the extent of social support in a patient with newly diagnosed Alzheimer’s disease.

Question 23

Factors impeding home visits

Answer 23

Lack of reimbursement
Busy pace of office practice
Poorly organized, sporadic home

Question 24

Who can benefit from home visits

Answer 24

Everyone
patients who have difficulty accessing outpatient facilities because of sensory impairment, immobility or transportation problem

Question 25

Way to make home visit make home visits more efficient

Answer 25

Clustering home visits by geographic location and within defined blocks of time
Nurse practitioners and physician assistants conducting visits as part of a home health care delivery team.

Question 26

Use of Telephone Calls in Medicine

Answer 26

For Virtual Home visits

Provider-initiated telephone calls can be used to reassure family members after a patient has had an acute illness or has been hospitalized.

Reinforcing patient compliance with new medications,

Following patients with chronic diseases

Reducing inappropriate use of primary care clinic or office services

Question 27

What is telemedicine

Answer 27

Use of communication technologies, such as two-way video-conferencing, to provide patient care across distances