A commitment to our community: Integrating a multidisciplinary home visit component into an urban Family Medicine residency curriculum

Issue

Impoverished urban neighborhoods experience poor healthcare access and health outcomes due to multiple barriers: under-insurance, stressed safety-nets, public transportation dependence, and spatial mismatches between provider location and patient communities. Academic medical centers have are obligated to respond to the needs of the surrounding communities, however face challenges in countering barriers. Clinical services delivered in traditional practices have not addressed the needs of marginalized populations. Family Medicine practices are uniquely suited to respond to these challenges through the discipline's commitment to treating patients in the community context and emphasis on disease prevention and health promotion.

Description

A multidisciplinary home visit program that bridges continuity gaps was integrated with family medicine physician training. The curriculum emphasizes culturally sensitive collaborative care, understanding of socio-cultural determinants of health, and social services education. Patient care emphasizes coordination and continuity of care as patients transition between the home/community and the office/hospital. Home visits are made by a team of resident and attending physicians, pharmacy students, and social worker.

Results

Since implementation, 16 residents and 17 students have participated in 76 home visits including newborn/postpartum evaluations, hospice care, elderly long-term care needs assessments, hospital discharge transitions, polypharmacy and medication adherence evaluations, home care needs and safety assessments, and insurance counseling. Qualitative feedback was positive; residents reported an increased likelihood of incorporating home visits into future practice and improved understanding of the divide between the office and patients' homes/neighborhoods. Quantitative outcomes indicate increased understanding of access barriers, environmental and socio-cultural influences on health, and social services.