Annual visits to patients over the age of 75-- who is missed?

BACKGROUND: In the UK, the GP contract requires annual consultations andoffers of home visits to the elderly. However, as many as 50%of elderly people refuse the offer of a health screen. OBJECTIVE: To describe the characteristics of elderly people who declinedthe offer of an annual home visit. METHOD: All elderly people aged 75 years and over, registered with ageneral practice of 13 full time and 3 part time doctors witha list size of 33,000 people, were offered a home visit. Datafrom this prospective cohort were linked with data from a communitysurvey two years previously, which had achieved a 95% responserate. The main outcome measures were perceived health status,perceived loneliness, morale score, physical and mental disability,use of primary care and social services. RESULTS: Thirty-six percent of all elderly people registered with thepractice declined to take up the offer of a home visit. Thoserefusing a visit had not recently joined the practice and hadvery similar distributions of all demographic and most healthand wellbeing characteristics to those who took up the offer.However, those declining appeared to have higher levels of morale(P = 0.010) and less contact with the general practitioner (P= 0.021) including an average of three weeks longer since lastconsultation with their general practitioner than those acceptingthe visit. CONCLUSIONS: There appears little evidence in this population that elderlypeople who decline a home visit are necessarily part of an ‘iceberg’of unmet need. Keywords. Elderly, GP contract, home visits, patient take-up.