Hi, in Malaysia (South-East Asia), home care services are still pretty much scattered and not coordinated. The bulk of home care is offered by non-governmental organisations (palliative care), certain public hospitals (geriatric care), postnatal care (primary care nurses) and private home nursing companies. The Ministry of Health Malaysia has recently announced the intention to strengthen domiciliary care (home care) to provide transition care for patients who are newly discharged.

I am working on developing the home care nursing service in our teaching hospital. What we do is that we have pairs of nurses who go out to do nursing procedures and see patients at their homes. Once every 2-4 weeks, we convene (nurses and doctor) to discuss cases to identify cases which require doctor input or complex cases. From the case conferences, we either plan a home visit together with the doctor or refer the cases for multidisciplinary interventions (dietician, physiotherapy, OT, speech or medical social worker). The nurses who visit the patients are our eyes and ears and hands. Doctors only step in when necessary.

This model is adopted from a large palliative care NGO in Kuala Lumpur (Hospis Malaysia) but we are offering our home care service to patients with chronic diseases who are homebound. Therefore we do not duplicate the services offered by Hospis Malaysia which is palliative care of excellent standards.

You may want to explore the FMCC (Family Medicine and Continuing Care) team in Singapore, who are even more established in offering home health care.

Hope this helps. Best wishes.

In Australia there is Community Nursing, including Palliative Care and Hospital in the Home Nursing for such things as Dialysis etc. where patients may live-in for a short period at a purpose built location to learn how to care for themselves or at least goal oriented, on-campus program and then move to their own homes to continue disease management. There is also support via phone and videocommunication links for certain services ranging from medical appointments, multidisciplinary team meetings and checking in with pateints to see how they are coping and to review data sent via phone or monitoring devices such as Blood Glucose monitors that link to ones computer and can be sent to the hospital.

Dear Firnandez - it depends very much on the country - and in most countries also on the insurance company. What is your research question - inclusion criteria?

I'm interested to know whether the primary health care includes home care, which patients are included in it and what services are offered.

For the first question:

The plan for domiciliary care under the Ministry of Health Malaysia is to be executed by the primary care team (currently being piloted in several states before nationwide implementation).  Postnatal home visits have been long established by the maternal and child health section of the public primary care clinics.  I am also a family medicine specialist who happens to have an interest in home care, and thus, am working together with the nurses to develop the service further.  In Singapore, it is also run by the Family Medicine / primary care unit. 

For the second question:

For the home care service offered by the teaching hospital I'm working in, patients referred to us are patients who have reasonable logistic difficulty to come to the hospital / clinic for nursing procedures, staying within the catchment area, and agreeable to the terms of service.  These include stroke patients, patients with spinal cord injuries, cerebral palsy, diabetic foot ulcers, post-amputation etc. 

For the third question:

Services offered are nursing procedures such as changing Ryle's tube, changing urinary catheters and suprapubic catheters, wound dressing, caregiver education and monitoring of blood pressure and capillary blood glucose.  We are working to extend our services and now we include doctors doing house calls for complex cases, and in future may coordinate with rehabilitation or dietetic services.  However, due to logistics, it is still very challenging to coordinate services from various other departments.  Our services are partially subsidized as our teaching hospital is under the purvey of the Ministry of Education, whereas clinics under teh Ministry of Health offer their services at an even more highly subsidized rates.  We don't have the facility for telemonitoring at the moment.  So I do envy the Australians as described by Ms Franks above.