Practice of internal medicine at home (outside hospital's walls): The experience of the internal medicine team of SOS Doctors in outhospital emergency medicine

Theodore Spiropoulos1, Spyridon Barbas1, Ioannis Salpigktis1, Dionissios Rodis1,George Theocharis1
1SOS DOCTORS, Athens, Greece
As population is getting older, house calls and emergency medicine services provided at home will increase. In Athens, Greece, SOS Doctors is a network of specialized physicians who provide medical home visits on a 24h basis and half of them are internists.
In this study we analyze the experience of internists of SOS Doctors in managing emergency health problems at home.

Purpose:

The aim of the study was to contemplate the characteristics of patients suffering from acute medical problems at home, the medical diagnosis of these patients and also the rate of admission to the hospital after a home visit. We compared these results with the characteristics of patients seeking care from an internist (I) or other medical specialists (OS).

Materials & Methods:

We performed a retrospective observational study regarding adult patients that they sought acute care at home from 01/01/2009 to 31/12/2011. We analyzed our database and compared patient characteristics, diagnosis and hospitalization rates.

Results:

SOS Doctors performed a total of 103.145 home visits during the years 2009-2011. 52.318 (50.7%) of them were performed by internists and 50.287(49.3%) by other specialists. More visits were performed in women than men in both groups. Internists visited less elderly (older than 65 years) patients 26.833 (52.8%) versus to other specialists who visited 37.552 (71.8%) (p<0,001).
More frequent diagnosis were upper respiratory system infections 9761 (19.2%), gastroenteritis 5247(10.3%), lower respiratory system infections 3264 (6.4%), positional vertigo 2862 (5.6%), urinary infection 1469(2.9%).
More patients visited by internists were admitted to the hospital 3721 (7.1%) versus to 1948 (3.8%) of admissions after other specialists' visits (p<0,001).

Conclusion:

Our data suggest that patients who need internists' home visits are younger than patients that need other specialists and more patients after internist's home visit need hospitalization. Patients visited by internist have more acute health problems than patients visited by other specialties and this can explain the higher rate of hospital admission.