Transcription:
House Calls for Your Children

Melanie Cole (Host): Some doctors still do make house calls. Do you have one that does? Pediatric Home Visit Programs from UVA Health System Pediatrics are something you should look into. My guest is Dr. Amy Brown. She's a pediatrician who runs the Pediatric Home Visit Program out of the UVA Health System Primary Care Center. Welcome to the show, Dr. Brown. Why are home visits so important? What is the difference between getting parents to bring their kids in for their well visits, for their appointments to the doctor's office, and the advantages of having your doctor come to you?

Dr. Amy Brown (Guest): Yes. Thanks so much for having me on the show today. Home visits are an incredibly useful tool for pediatricians, and really, all of the auxiliary services that are involved in child health in the community. Somebody said, "A picture is worth a thousand words." That is definitely true. When you go to a child's home, apart from a 10- or 15-minute visit in the office, you gain so much more information about the child's circumstances, the family dynamics, safety issues. You are able to better assess a child's development in their own natural environment. It helps pediatricians, I think, guide services for these children and plug them into community resources that prepare them for school readiness, and catch kids that are falling by the wayside.

Melanie: Now, Dr. Brown, this is not necessarily for underserved population, is it?

Dr. Brown: No, absolutely not. The Department of Health and Human Services is really taking a look at this, especially with the authorization of the Affordable Care Act. It's primarily focused on early interventions targeting prenatal, postnatal visits, and infants and young children. Doctors have been doing house calls for generations. Decades ago, this was the standard. Your doctor came to your home. They knew your family. They knew where you lived. I think that's an art of medicine that we have really lost in our generation, in our current healthcare system, because doctors have lost the ability to know their patients that way.

Melanie: Do you all have enough time in your day? Because I see pediatric offices, and I applaud all of you pediatricians, because what a field you have entered. But do you have enough hours in your day to see as many patients as you could if you have to go house to house?

Dr. Brown: It's certainly difficult, especially with current reimbursement structures with health insurance companies. But what we've tried to do at UVA, we train a lot of future pediatricians here. We have a well-developed residency program. Back in 1995, one of our attending physicians really had the forethought to say, "You know, this is important for young physicians to understand where their families come from and the neighborhoods in which they live and to get outside of the hospital." What we've done is we've incorporated that into part of the residency training, where once a month, we take a team of physicians, small group of physicians, and we're able to spend an entire day going and visiting our primary care patient from our pediatric center here at UVA. It's been effective, and I hope that the community also sees the services for them that they don't have to fight the traffic and drive four kids into the clinic. We make it actually useful for them to stay at home, and we bring everything to them.

Melanie: I think it's awesome. I would absolutely love a pediatric home visit because fighting the traffic, waiting for the other kids to finish. Pediatric offices are well-known to be germ infested.

Dr. Brown: Yes, definitely.

Melanie: It's like you go in there for a well visit and you're worried, you're looking around and all the kids that are in there being sick. I think it's incredible that you're doing this, and certainly at UVA Health System. Now, early intervention. You can catch children with any kinds of needs for early intervention. Also, as you stated, looking at the home environment. Are there effects that you can look at maybe decreasing child abuse, possibly, or smoking in the home, educating the entire family as opposed to just what you do with the child?

Dr. Brown: Absolutely. Some of that never comes out in an office visit. But when you're in a home, you see such a better picture of what's going. It's a great opportunity to sit there and say, "You know, I noticed such and such about your house. I noticed you have stairs but you don't have a gate on, and you have a toddler." Then we are able to discuss the risks of fall hazards or other safety issues in the home that we would have never been able to know in the office. That's something that is really coming down the pipeline when we look at the outcome measures of home visiting programs for young children and infants. But they're really trying to improve prevention of child injuries, prevention of child neglect, child abuse, addressing early developmental skills and school readiness. I think we're going to see that there's some great research that comes out of that.

Melanie: In the high-risk populations, I would suspect that this is even doubled in its long-term effects that you can be looking at things like child abuse, as you say, and neglect, and even possible criminal behavior of the parents. You can get a handle on all of it, and you're the expert, so you can help the family as a unit.

Dr. Brown: Absolutely. There have been some studies that have shown kids or young children with families that received home visits were able to keep their well child checks 3 to 10 times higher than families who didn't. That just ties them back into the medical system where they actually have a medical home. For us, we see it as we're our patients medical home but we're out in their communities. We're out in their houses, and we know their neighbors. For us, that's a great benefit. That's why many of us went into medicine in the first place.

Melanie: Is there a different type of care you provide at the home visit? You're still doing blood pressure. You're carrying around your sphygmomanometer with you. You're still doing vaccinations. Are you carrying all these things with you?

Dr. Brown: Yes, absolutely. We actually take everything into the home so we can do the head circumference, the weight, the height. We bring vaccines on our visits. Many times, we're doing more extensive developmental assessments than we would be able to do in the clinic. I think another benefit of the home visits for us is to really plug those kids in that have chronic medical illnesses. We're not sure what the compliance is at home with their therapies, and so we're able to address kids with chronic asthma or chronic eczema, ADHD. We do really a full spectrum of visits in the home.

Melanie: Plus, you're making sure that these kids are getting vaccinated, where maybe parents say, "It's just a well visit. I'll blow it off this year. We'll do it in a couple of months." This way kids are getting their flu shots and their vaccinations on time because you're coming to them.

Dr. Brown: Yes, absolutely. There are a lot of kids that have missed well child checks, so it's an opportunity for us to really call those families and say, "You know what? How about we come to you?" Because sometimes transportation is an issue or missing work for a parent is a big issue. To be able to go to the house and take care of that and catch up on their vaccines and really assess how this child is doing after not having seen them for a couple of months, it's very helpful for us, and important.

Melanie: Now, with UVA's Child Care In-Home Pediatric Visits, tell us a little bit about how you go about getting involved in this program.

Dr. Brown: Sure. We offer home visits typically on the third Friday of every month, then we try to stack the whole day with families that we're going to see within up to an hour of our academic center here in Charlottesville. Well child checks, it's fixed visits, it's follow-up visits from the ER, newborn follow-up visits from the new born nursery, and anybody who considers the Pediatric Primary Care Center their medical home are eligible to participate in the program.

Melanie: Do you have to sign up? Do you have to meet special requirements? Or if you're just part of this pediatric care program, you can get in on that? It's third Friday of every month, correct?

Dr. Brown: Mm-hmm. Yes. Usually, we consider everybody eligible. Obviously, we try to save some appointments for some of those kids that have been lost to the medical system, so can really pull them back in and then get them caught up in the vaccines or whatever. But anybody is eligible that considers us their primary care or clinic or medical home.

Melanie: What a great reason to use UVA Health System's Primary Care Center Pediatric Home Visits. You're listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.