Acute Visiting Scheme
Acute Visiting Scheme - Overview
In April 2009, GPCARE commissioned an innovative programme called the Acute Visiting Scheme (AVS) from our local Out of Hours medical services provider (BARDOC).
The AVS scheme can be activated if a patient calls their GP’s surgery and requests a home visit. When receiving the call, the receptionist will take all the relevant details and pass these through to the doctor. The doctor will then make a clinical decision as to the urgency of the call, the needs of the patient and whether the he or she needs to visit the patient personally.
If the patients own doctor feels that they need to attend because of their clinical need, they will advise the patient of the likely time for visiting. If the doctor feels that the patient could be treated by another doctor working in the AVS scheme, they will ask the patient if they would be willing to see another doctor. If the patient agrees, the surgery will securely send all relevant information to BARDOC.
On receipt of this information, the doctor working for the AVS scheme will be informed of the need to visit the patient, some necessary background clinical information and the nature of the current problem.
The visiting doctor can then visit the patient and determine what actions need to be taken. If necessary, a prescription can be provided. After visiting, all relevant information about the problem, and treatments is sent back to the patients own GP.
Benefits to the Patient
The local benefits of the Acute Visiting Scheme is that patients have the opportunity to be seen much sooner if they request a home visit from their own GP. If the Doctor has just commenced their surgery and a house call is requested, the patient may have to wait several hours before the GP is able to attend.
The AVS doctor has visited patients of all age ranges, from very young patients (under 10 years) to patients aged 91 years (and older). In most cases, immediate or necessary treatment has been provided and the patient advised to contact their own GP for further help or treatment if necessary.
Healthcare Reviews for Residential Home Patients
During the first three months of operating the AVS scheme, it was agreed by GPCARE doctors that many patients who were resident in nursing or residential homes would benefit from a review of their current treatment(s) to ensure that they were still effective for the patients needs.
Working with the GPCARE Prescribing Advisor, the AVS GP reviewed current treatments for most patients’ who agreed to a visit and consultation. During the consultation, routine checks were undertaken by the doctor and following this, a discussion about current treatments, between doctor and pharmacist and possible treatment improvements were recorded. These recommendations were sent back to the patients own GP for consideration. In most cases, no changes were required and patients were receiving the correct treatments for their condition.
In some cases, the patient decided that they did not need any further medical treatment and so declined a consultation. Most patients did agree to see the doctor and discuss their current treatments. Wherever possible, comments from staff in the residential or nursing home were obtained to supplement the clinical information supplied from the patients own surgery.
Comments received during the Health Care Review scheme from both patients and carers were welcomed. Most felt that this scheme was valuable and consideration will be given to further developing this in the future alongside the Acute Visiting Scheme.
Outcomes to Date
We know from the information provided about the AVS scheme that since April 2009, almost 600 local patients have been seen by the GP and almost 300 patients who are resident in a nursing or residential home have had a Health Care Review.
Due to the confidential nature of the information shared during the consultation between patient and GP, there are limitations on how the effectiveness of the scheme is assessed.
An experienced doctor and the GPCARE Prescribing Advisor assessed the information provided by the visiting doctor and agreed that in approximately 30% of cases, the timely visit of the GP had prevented a hospital admission and had enabled the patient to receive the appropriate care within their own residence.
For Health Care Reviews, recommendations were made to the patients own GP in a small number of cases which in the opinion of the doctor and Prescribing Advisor could have improved longer term patient care.
A patient evaluation of the AVS scheme is currently being undertaken. These views will be added to those obtained from GPCARE doctors to improve the scheme during the autumn and winter months.
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