Qualitative study to explore which components of home-based primary care may reduce emergency department visits among older adults.

OBJECTIVE: Home-based primary care has been suggested to reduce emergency department visits among vulnerable older adults but how it should be organised to achieve this effect is unclear. This study aimed to increase the understanding of how older adults receiving home-based primary care and their family caregivers' experience care during the period prior to an emergency department visit and to identify components of home-based primary care delivery that could help reduce such visits. DESIGN: Qualitative study using semi-structured interviews with older adults receiving home-based primary care who had recently visited the emergency department, along with their family caregivers. Interviews were analysed using inductive thematic analysis. SETTING: Interviews were conducted in the homes of informants receiving home-based primary care in Region Stockholm, Sweden, 2022-2023. PARTICIPANTS: Fourteen adults aged ≥65 years receiving home-based primary care who had visited an emergency department within the past 3 months were interviewed; seven interviews also included a family member. RESULTS: An overarching theme, Trust as a prerequisite for timely emergency assessments in home-based primary care, describes how patient trust-in home-based primary care in general and in specific individual healthcare professionals-seems important in reducing emergency department visits, especially when patients experience symptoms of uncertain urgency or gradual onset. Four subthemes describe how primary care may build trust: through (1) access to care, (2) medical competence, (3) respect and relationship and (4) coordination and teamwork. CONCLUSION: Trust in both home-based primary care in general and in individual healthcare professionals is crucial in reducing emergency department visits among older adults receiving home-based primary care. Trust may be strengthened by accessible and competent care, familiarity with both general practitioners and the responsible nurse and working as a collaborative team.