Home health visiting has many positive benefits but more evidence about cost-effectiveness is needed

McNaughton, Diane B. PhD, RN

Rush University College of Nursing, Chicago, IL 60612, USA

Elkan R, Kendrick D, Hewitt M, Robinson JJA, Tolley K, Blair M, Dewey M, Williams D, Brummell K. The effectiveness of domiciliary health visiting: a systematic review of international studies and a selective review of the British literature. Health Technol Assess 2000; 4(13): 1-339 .

Evidence-based Healthcare 5(3):p 67-68, September 2001.

BACKGROUND

Home visiting involves periodic domestic visits (usually by a health professional) to support individuals and families. There are several types of home visiting programmes, each with different goals and methods.

OBJECTIVE

To examine the effectiveness and cost-effectiveness of home health visiting for parents and young children; elderly people; and those with special needs.

METHOD

Systematic review; up to 1993.

LITERATURE REVIEW

Search strategy included two electronic databases, journals; reference lists; and key individuals and organisations.

INCLUSION/EXCLUSION CRITERIA

All prospective studies with control or comparison groups examining the health outcomes associated with British health visitors or international personnel with similar roles were eligible. Seventy-seven articles were included.

OUTCOMES

Various health outcomes.

DATA EXTRACTION AND SYNTHESIS

A systematic procedure was used to extract data and assess methodological quality. Meta-analyses were undertaken where appropriate.

MAIN RESULTS

Home visiting was associated with improved parenting skills; enhanced home environment; modification of selected childhood behavioural problems; improved childhood intellectual development; improved postnatal depression detection and treatment; enhanced maternal social support; increased breastfeeding; reduced unintentional childhood injury; reduced mortality amongst the elderly; and reduced institutionalisation of at-risk elderly groups. There was no evidence of effects on childhood motor development or diet; maternal use of community resources; continuing education or employment, or subsequent pregnancies; hospital admission, functional or psychological status, or quality of life for elderly people. There were limited cost-effectiveness analyses; however, home visiting has the potential to reduce net costs, including hospital expenditure.

AUTHORS' CONCLUSIONS

Home visiting in isolation may not lead to improved health outcomes. But when targeted towards at-risk groups, used in conjunction with other interventions, involving multiple family and individual needs and based on sound professional judgement, significant effects can accrue. More cost-effectiveness research is required.