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The Hamilton Spectator published an opinion piece on house call service by Dr. Katalin Ivanyi (MD grad '91 FM Faculty Member)

Mar 20, 2015

House call service a risk to patient care

Tests duplication, errors and communication gaps increase as health care providers increase         

As a local family doctor, I wholeheartedly and passionately support all patients having timely access to medical care, as well as receiving care in their home environment if they are unable to travel to a health clinic. I have built my career for the past 20 years on these principles. The clinic I work in provides both in-clinic and in-home services every single day of the year. Many, if not most, of our local family medicine teams also provide care in a patient's home when necessary.

As a result, I have concerns about the arrival of MD HomeCall Inc. to our Hamilton community, as reported in The Spectator on Friday, March 13.

I could support the work of MD HomeCall Inc. IF the company:

1. focused on providing services for only those patients who currently do not have access to a family doctor in our community;

2. worked with existing family medicine groups to connect these patients for ongoing care, and;

3. provided home-based care in the most cost-effective way possible.

Sadly, none of these statements reflect the real objectives of this organization.

The primary aim of everything I and my colleagues do focuses on the safety and quality of the care being delivered to our patients.

Regardless of the excellent credentials of the individual doctors who have signed up to provide MD HomeCall Inc.'s services, this model poses clear risks to a patient's long-term safety and care.

Offering physician services to patients who have an existing relationship with a family medicine team creates potential worrisome gaps in their care. This concern increases for those patients with more complex chronic health needs, such as the people receiving CCAC services, with whom MD HomeCall Inc. is hoping to establish a partnership.

It's a simple case of "too many cooks in the kitchen:" the chances of duplication of tests, medication errors and gaps in communication all increase dramatically when more providers are involved in a person's health care. This is especially concerning when there isn't a seamless communication system in place.

MD HomeCall Inc. has yet to contact Stonechurch Family Health Centre, the clinic where I work, to discuss any mode of communication between our two groups of providers, if they are to see one of our patients in their home.

We also need to talk about that greatest taboo — money. I am deeply worried about the unnecessary costs to our already stretched health-care system incurred by this company. According to their website, they offer "non-urgent medical care for most common illnesses and minor injuries."

If I see a patient for an issue such as this in my office and bill OHIP, the charge to the provincial coffers is $33.70. A doctor in a walk-in clinic would currently charge $35.40 for the same service.

For a similar issue to be assessed in a patient's home during the hours that MD HomeCall Inc. is advertising, the cost is $147.55 on weeknights, and $164.05 on weekends. The company website also instructs interested physicians how to take advantage of other financial bonuses, which were created to reward doctors for providing home visits to those families who truly could not access health care services outside of their home.

Remember, this service is being proposed for "non-urgent, relatively minor" health issues. These non-urgent issues can be, and are, very safely addressed the next day by a doctor or nurse practitioner who has access to the full extent of the patient's health information, and is familiar with them and their family.

I fully appreciate the need to look for any and all opportunities to continue to increase access to medical care for people who do not currently have access to a family doctor. Unfortunately, a service such as MD HomeCall Inc. does not help address this important issue in any meaningful long-term way.

Rather, we need to focus our resources on projects and recruitment aimed at continuing to build primary health care capacity in our community.

This would ensure that everyone who is interested in doing so would have access to a family medicine team to provide them with the high quality primary health care that all deserve in our wonderful city, province and country.


Katalin Ivanyi, MD, CCFP, FCFP, is Unit Director with the Stonechurch Family Health Centre and part of the Department of Family Medicine at McMaster University.


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