Health Visitors

Ezra Klein has a piece this morning about a program that has had great success in improving outcomes and reducing costs for elderly Medicare beneficiaries via the use of health visitors (nurses going weekly or monthly to the homes of those at risk).

Below is a post from my old blog (Aug 19, 2009) recounting my personal experience with health visitors when I lived in England with my wife and first infant child (who is going to college in the fall!). It is fairly common for GPs in the NHS to have a visiting nurse….nothing new under the sun and all that.

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A vivid Memory of the NHS

I did a post-doctoral fellowship at the University of Manchester, in Machester, England. My wife and I moved to Manchester when our oldest daughter was 2 months old (who is going to start high school next week, yikes!). This meant that we used the NHS a fair amount, because of well child visits, immunizations and little babies get sick. But, I will never forget my first interaction with the NHS.

We had been living in our (slightly) dodgy neighborhood for 4 or 5 days and I hadn’t started to work yet. There was a knock on the door and I answered, only to to find an older woman at the door who identified herself as a nurse. She said simply, I am here from the local GPs office, and I hear that you have a small baby. I said, ‘well yes’ while thinking how do you know or care. She picked up on my puzzlement and said that the neighbors had told her that the newbies had a baby. The neighbors who told her were a couple of elderly women, each of whom lived alone. They told this visiting nurse because she checked in on them fairly often, to see how they were doing.

The nurse asked if she could come in, because she would like to meet my wife and the baby and check out the house. My wife and the baby were out shopping. She asked if she could check out our house for safety, and I said, well ok. I have a Ph.D. in Public Health, so I was filled with a mixture of awe (actual public health) and horror (invading my personal space).

She proceeded to measure the temperature of the hot water heater (too hot, scalding danger), measured the distance between the tines up the stairs (too broad, choking/hanging risk because the babies head could fit through), and showed me a place near the back door that was very sharp and said that as my daughter began to crawl, it would be a problem. OK.

Then my wife got home.

Who is that? I told her. She wasn’t happy. My wife is a nurse, and in her experience when nurses visit your house it is as part of a home study when someone is about to be declared an unfit parent.

And when your first born is just 2 months old, you feel unfit!

The nurse began asking about my wife about breast feeding (already doing it), and asked about what immunizations our baby had and when we should come and get the next shots (this was a question she had), having you been feeling down (yes, we moved to another country with a 2 month old and it won’t stop raining). We asked the nurse where we could go to get a GP to register with to receive care, and she replied, ‘you can go to any GP, but most everyone in your neighborhood comes to the local GP.’ In turned out that the GPs office was around one-third of a mile from our house. So, a few days later we went and registered.

The nurse spent most of her time visiting those with small babies, the elderly and persons with special needs who were cared for by the GP who employed her.

That was the GP practice we picked, just like most of the neighbors. These GPs and nurses cared well for our family while we were there. It was actually more like a multi-specialty group practice than what I expected to find, and they had one GP who tended to focus on caring for new babies. The care we received from the GP was good over the time we were there. But, our first contact with the NHS, was a nurse who came to me, and wanted to measure the temperature of my hot water heater.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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