Returning to our roots: Healthcare in our community

Not too long ago in the history of our country, there existed physicians who would travel around seeing patients. These physicians would do such things as make “house calls” or “home visits”. They were there in the home when the patients needed them. They were seen traveling around the community delivering care.These providers went to their patients – they did not wait on the patients to come to them.

When was the last time you heard of a medical home visit? Have you ever been seen in your home? What has changed in healthcare that we must go to a building in order to receive services? Why are services not coming to us? When did healthcare become removed from the community?

While there exist new and exciting technologies that allows providers to see patients in their home without actually traveling to the patients home, it sill seems that fundamentally we have shifted healthcare away from our community and into our medical complexes.

Why don’t we take healthcare to those who need it most?

As we have written about before on this site, Dr. Jeff Brenner and his Camden Coalition work have done just that. They have found those patients who often need the most services and tried to take healthcare to them.

In the hustle and bustle of our busy lives, we are looking for efficient, effective and easy to access healthcare. Most of the time, we are going to look for what’s closest to us. Ideally, these services would be in our community, and in some cases, these services are close to where we work. In an increasing number of cases, healthcare services are being offered at work. From Kaiser Health News:

“Until the 1980s, workplace health clinics generally existed to treat people who were injured on the job. Although that is still a key function, many employers are expanding the clinics’ role to include primary health-care services. In 2010, 15 percent of employers with 500 or more employees had clinics providing primary-care services, according to the consulting firm Mercer. Another 10 percent said they were considering providing those services this year or next.”

And really, this is not a surprise. We are spending more and more time at work. Employers benefit when they have a healthy workforce that can be productive (both present and effective). While bringing primary care and other healthcare services to our work sites is important, is this really bringing healthcare back to the community?

There is much more to say about this topic, but I wanted to open it up to you and hear what you all think.

How can we better bring healthcare back to our communities?

What are the benefits of this approach? Is it even something that we want?

Are we satisfied always needing to take our healthcare concerns to someone? Is this the best way?

Is returning to our roots (house calls and the like) important to even consider in the current healthcare climate?

Let us know what you think. I will compile comments into a future post on this topic.

Dr. Miller has his doctorate in clinical psychology and is an Assistant Professor in the Department of Family Medicine at the University of Colorado Denver School of Medicine where he is the Director of the Office of Integrated Healthcare Research and Policy. His core task is to integrate mental health across all three of the department’s core mission areas: clinical, education, and research. Opinions expressed here are his own and not those of his employer.

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  • Carmen

    As is usually the case, the argument of funding is the biggest barrier to providing the care you describe. However, there are glimmers of hope. For example, the 2010 Affordable Care Act has funded 10 nurse-managed health centers (there are some 250 in the U.S.) to provide core services to underserved areas. According to a recent article on nurse-managed clinics, these organizations which servie low-income and uninsured people, “boast a strong record of achievements and outcomes.” Further, some studies demonstrated lower hospitalization rates among patients in nurse-managed centers. Even more revealing, the same article noted that, “a systematic literature review published in the British Medical Journal in 2006 found no difference in the quality of care between physicians and NPs, and found NPs had greater patient satisfaction ratings and spent more time with patients.” Assuming the ACA survives Supreme Court scrutiny, I hope this effort achieves greater support to make health care more local and accessible.

  • pursuitofPH

    Home visitation programs are not unheard of even in this day and age, though they seem to be largely concentrated in providing services to pregnant and young mothers, as well as children and adolescents. Child Trends provides a nice review here – – which gets at the issue of making sure that whatever we do, let’s test it and make sure it actually works.

    I think conceptually, house calls are definitely appealing in that they bring down logistical barriers to care, allow for care to be provided in a friendlier/more comfortable environment, and allow the physician to take into consideration a number of social determinants of health that might go unnoticed if the patient just came to a clinic/hospital (the health and safety of their neighborhood and house for example).

    If the funds and personnel can be set aside for this kind of care, things to keep in mind include 1) evaluating and revising procedures accordingly to ensure impact and efficiency and 2) incorporating prevention/health promotion (not just treatment) – here’s an interesting example:

  • Ann Becker-Schutte


    I think that these questions are critical. I agree with Carmen’s points about looking at innovative models, where many levels of service provider can be engaged in health care. During a serious illness, I did have a nurse who came to my home. That service was a great support during a difficult time. I’d love to find ways to implement more care like that.

    Thanks for getting the wheels turning!


  • Nate

    I feel like people in general are more isolated from their communities. CHCs are so strapped for time and funding, I don’t see this as a viable option without structural change. Currently, only those who can afford concierge medicine have access to this level of care. Which is a shame, because they’re certainly not the most vulnerable population…

  • JoelHigh

    I think it’s time that we really began to look at healthcare in new and innovative ways (which actually maybe old and forgotten ways). One of the ways that we can address the healthcare needs of many individuals in a primary care context is to look to nurses to for caregiving. We already have a model for this in examples such as the Visiting Nurses Association and other home healthcare providers. Nurses have been doing home care for as long as physicians have. Building teams of RNs and APRNs along with physicians could certainly help us create a new model using old ideas for caring for people at home.