As far as we are aware this is the first survey of patients requiring home care from the perspective of the GP in Austria. As an essential result of the study it turned out that the focal point in the management of the diseases of GPs' home care patients is not the cancer patient in the terminal stage, but the patient with degenerative diseases of the CNS and the musculo-skeletal system.
About 85% of the patients were cared for by one or more of their relatives. 2/3 of the patients were female and 5 years older than males. This correlates with the higher life expectancy for women [12, 13].
The number of 2.2 (1997) and 2.7 (2004) home visits per month, was rather low considering the number of coexisting diseases. A possible explanation for this result could be that regular home visits by the GP and other health care professionals support the relatives providing care, foster the health status of patients and help to prevent deterioration .
Concerning the change in the proportion that has permanent home care, going from 60% 1997 to 40% in 2004 we do not believe that this change is due to changed living arrangements, as these did not change appreciably in this area. Elderly people, as mentioned above, usually live alone (regularly visited by their children or other relatives living close by) or in small families. Also 1997 it was already very infrequent that elderly people lived in extended families and this situation did not change until now.
A possible explanation for the reduction of elderly people needing permanent care could be that the number of nursing homes has increased and that access to nursing homes is more easy and better accepted [10, 13].
Comparing the functional parameters between 1997 and 2004 shows a trend in the direction of an improvement in most of the parameters assessed. The improvement in the functional parameters parallels the decrease in the severity of the degrees of the official Austrian grading system. This trend could indicate that patients with more serious medical problems are kept in nursing homes, as we found evidence for an increasing trend (a plus of 20,3% between 1997 and 2004) for institutionalization of elderly people in this area with a rate of 126 for every 1000 people aged 75 or older [10, 13]. A more optimistic interpretation could be that the continuous care by relatives, professionals and physicians improves functional parameters over time.
Diseases of the CNS constituting the majority of the cases remained equally frequent and cause a heavy burden for those who care for these patients. Two thirds of all patients show an orientation in time and location, which can be explained by the fact that certain diseases of the CNS (e.g. strokes, sclerosis, sequelaes of brain trauma, Parkinson's disease) do not regularly cause an impaired orientation, but are nevertheless impairing the patient enough to make him unable to care for himself [15–18].
The increasing number of the diseases of the musculo-skeletal system is not surprising, considering the general trend in civilized nations towards a high prevalence of musculo-skeletal disorders . Obviously there exists a contradiction between the bettering of the functional parameters and the increasing number of musculo-skeletal diseases, which possibly can be explained by an increasing number of less severe cases despite the higher mean age of patients in the second observation period of 2004.
The tendency towards more severe cases of diabetes parallels the increasing prevalence of diabetes at the national [20, 21] and international level .
Malignant diseases constituted only a small proportion of the diseases leading to the need for home care. Despite their low number, patients suffering from terminal malignant disease require special competence for example with regard to pain management. The cooperation between the patient, relatives, nursing professionals and palliative care teams is therefore of high importance [23–26].
The high prevalence of marasmus senilis (19 respectively 10%) compares well with the results of other studies which show figures between 5 and 37% [27, 28].
One of the strengths of our study is that it gives a first insight in the underlying diseases leading to the need of home care and in the functional status of patients living in their private homes who are cared for there by their GPs. Another perhaps unexpected result is the high involvement of the relatives in the caring process in addition to professional care givers.
One of the main limitations of our study is the small number of practices in the restricted geographical area of eastern Austria. Another limitation is that the practices of the two study periods were only partially identical. So the comparison of the results of the two periods could have been biased by this.
In accordance with the existing literature we found that degenerative diseases of the brain and the skeletal system are the main reason for chronic disability also in our group of home cared patients and that home visits play an important role in the process of continuous home care [1, 5, 6, 8, 12, 17, 19].