A study of selected home care programs : a joint project of the Public Health Service and the Commission on Chronic Illness.

  • United States. Public Health Service.
Date:
1955]
Catalogue details

Licence: Public Domain Mark

Credit: A study of selected home care programs : a joint project of the Public Health Service and the Commission on Chronic Illness. Source: Wellcome Collection.

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    by the physician. The agencies providing these services were the Burlington Welfare De- partment, the Howard Relief Society, and the Vermont Catholic Charities. Other Services. Laboratory tests, X-rays, drugs, medical supplies, transportation, hos- pital equipment, and sickroom supplies were provided. Since most of the arrangements for these services were on an informal basis and no records were kept, it was impossible to obtain data on the amounts of services provided. Characteristics of Patients No record was kept of the number of different patients served in this home care program each year, nor were compilations made of the ages, diagnoses, or other characteristics of patients. There were on file records of approximately 5,000 different patients who had received home care services at some time between 1946 and 1953. It was estimated by program personnel that about 1,500 to 2,000 different patients were served each year, about 200 of whom were chronically ill patients who received a home visit by a physician at least once a week, plus additional services as needed. During the study, a count was made of ap- proximately a 5-percent sample of patients who had received home medical visits. It was found that, of 408 medical visits in the sample, 118, or about 29 percent, were made to patients with chronic illness. Home Care and Professional Education The University of Vermont College of Medi- cine appointed a hospital resident from the Mary Fletcher Hospital to provide home med- ical care for a 6-month period. The resident was required to have at least 1 year of intern- ship and was selected from the residents in medicine. The resident, under the supervision of the director of the dispensary, was responsible for medical services in the home to indigent and medically indigent patients. He supervised the fourth-year medical students during their assignment to the service and, in addition, made rounds at the Mary Fletcher Hospital to evalu- ate and approve patients for home care. He also made weekly rounds at the City Poor 93 Farm, where he gave medical care 'to 8 to 10 patients with chronic illness. He likewise visited public assistance recipients in nursing homes. The 44 students in the fourth-year class were assigned to the service for 2 or 4 weeks full time. Students with only 2-week assignments spent an additional 2 weeks with a general practi- tioner. Only two or three students were as- signed at any one time. The objectives of the training were: To gain experience with illness at home. To learn about types of illness not seen in a hospital or outpatient department. To obtain training in the management of patients with acute and chronic illness at home. To observe the effects of marginal living on health; To increase social consciousness. Each student was oriented to the program by the resident on the first day of his assign- ment. Students were responsible for accom- panying the resident on home visits, planning with the resident for the course of treat- ment, and making followup visits. Students were also responsible for following patients ad- mitted to the Mary Fletcher Hospital and for checking supplies and keeping the physician’s bag ready for use. In the future, it is planned to have the stu- dents attend the dispensary every afternoon during their assignment to the service. This will allow the students to see the patients who have been referred for outpatient service. Developments Within the Program During the first 20 years, the program was operated by having a local physician provide home medical services to patients and partici- pate in the teaching of medical students. This physician was employed by the College of Medicine of the University of Vermont. In 1947, the plan was changed and a hospital resident was assigned for 1 year to provide care to patients and to assist the program director with the teaching and supervision of medical students. In the fiscal year 1952-53, the resident as- signments were for a 6-month period, but, beginning with the fiscal year 1953-54, the