General practitioner involvement in hospital in the home. The hospital's view.

INTRODUCTION

Programs involving hospitals and general practitioners (GPs) have become more commonplace, with a greater emphasis on integration of health services emerging over the last generation. Hospital in the home (HIH) refers to the delivery of acute hospital services such as intravenous therapy, anticoagulation and wound care to patients in their own homes. This study sought to determine the extent to which HIH units had involved urban GPs, issues related to GP involvement, and the likely future of such involvement.

METHOD

Telephone administered structured survey to all urban HIH coordinators/directors in Melbourne, Australia.

RESULTS

All 14 identified HIH coordinators were interviewed. Five units reported a direct role for GPs, six reported no role and three reported a limited role in managing intercurrent illnesses. Coordinators felt that variability of GP response and skills, GP availability and patient control were significant issues. An increase in future GP involvement was uncertain and conditional.

DISCUSSION

One-third of urban hospitals surveyed have involved GPs in their programs. However, issues such as variability in skills, enthusiasm and availability threaten expansion of such involvement. This calls for a review in the way GPs are involved in hospital programs, and for better relationships with hospital nursing staff. Limiting the number of involved GPs in any hospital-GP program may offer advantages to both groups. Despite the movement of hospital work into the community, GP involvement in such work is not guaranteed.