Home-based care
===============

* Dawn E. Davies

I appreciate the *CMAJ* news article by Erin Walkinshaw regarding the increased need for house calls by physicians.1 As a pediatrician who participates in home-based palliative care, I would add that the need extends far beyond that of doctors making house calls. Entire health systems of community-based professionals need to emerge in order to stem the flow of patients — who might be better served at home — to acute-care facilities. Acute care is the default for families when community care is inadequately resourced.

I am lucky to live in the only Canadian city (of which I am aware) that has 24/7 access to pediatric nurses who are trained in pediatric palliative care. In my “black bag” there are continuous opioid infusions, central venous lines, phlebotomy supplies and treatments for seizures and hydration, to name a few items. Only within a system of continuous care in the community are patients able to stay in their homes and receive high-quality treatment for serious illness. Until we make seismic shifts in how we view health, illness and community, many of us will present to our local emergency departments for want of all kinds of care that might be better delivered at home.

## Reference

1.  Walkinshaw E. Back to black bag and horse-and-buggy medicine. CMAJ 2011;183:1829–30.
    
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