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GP home visiting in 18 European countries: adding the role of health system features.

Boerma, W.G.W., Groenewegen, P.P. GP home visiting in 18 European countries: adding the role of health system features. European Journal of General Practice: 2001, 7(4), 132-137
To describe and compare GP home visiting in 18 European countries and to test a set of hypotheses concerning the independent role of GP personal characteristics, type and organisation of the practice, and particularly, features of the healthcare system.

Methods
Data were used from the European Study of GP Task Profiles, collected by means of a uniform postal questionnaire in the national languages. Dependent variable is the self-reported number of home visits made by the GP. Independent variables at GP level are: GP's age and gender; involvement in out-of-hours care; urbanisation of the practice; mode and size of the practice; estimated over-representation of elderly, young children and socially deprived in the practice. At national level: gatekeeping position, employment status and density of GPs. In the multivariate analysis a hierarchical linear model was used in order to take into account the variables at two levels.

Results
Frequencies of home visits differed considerably, both between individual GPs and between countries. Correlates at practice level, known from the literature, were confirmed, such as age and gender of the GP and composition of the practice population. Important additional explanation was found at health system level. Numbers and variation in home visits among GPs were much lower in countries where GPs have a stronger position as gatekeepers. For independently working GPs the number of home visits was generally higher than in other countries.

Conclusions
Home visits are not lost ground for general practice. GPs in strong position can more easily decide on home visits on the basis of need. In the future, more pressure on home visits must be expected. This will ask for solutions which go beyond the individual level.