Physician home visits in Ontario: a cross-sectional analysis of patient characteristics and postvisit use of health care services

Abstract

Background: It is unknown how much of current physician home visit volume is driven by low-complexity or low-continuity visits. Our objectives were to measure physician home visit volumes and costs in Ontario from 2005/06 to 2018/19, and to compare patient characteristics and postvisit use of health care services across home visit types.

Methods: This was a retrospective cross-sectional study using health administrative data. We examined annual physician home visit volumes and costs from 2005/06 to 2018/19 in Ontario, and characteristics and postvisit use of health care services of residents who received at least 1 home visit from any physician in 2014/15 to 2018/19. We categorized home visits as palliative, provided to a patient who also received home care services or "other," and compared characteristics and outcomes between groups.

Results: A total of 4 418 334 physician home visits were performed between 2005/06 and 2018/19. More than half (2 256 667 [51.1%]) were classified as "other" and accounted for 39.1% ($22 million) of total annual physician billing costs. From 2014/15 to 2018/19, of the 413 057 home visit patients, 240 933 (58.3%) were adults aged 65 or more, and 323 283 (78.3%) lived in large urban areas. Compared to the palliative care and home care groups, the "other" group was younger, had fewer comorbidities, and had lower rates of emergency department visits and hospital admissions in the 30 days after the visit.

Interpretation: About half of physician home visits in 2014/15 to 2018/19 were to patients who were receiving neither palliative care nor home care, a group that was younger and healthier, and had low use of health care services after the visit. There is an opportunity to refine policy tools to target patients most likely to benefit from physician home visits.

Figure 1:

Annual physician home visits per 10 000 people in Ontario, 2005/06 to 2018/19, by type of visit. Dotted vertical lines at 2005/06 and 2012/13 mark the introduction of premium billing codes for palliative home visits and higher-volume incentives for primary care home visits, respectively.

Figure 2:

Annual total physician billings for home visits in Ontario, 2005/06 to 2018/19, by type of visit. Dashed vertical lines at 2005/06 and 2012/13 mark the introduction of premium billing codes for palliative home visits and higher-volume incentives for primary care home visits, respectively.