House call service offers old-school care with a modern approach

House calls might seem like a throwback to a bygone era of medicine.

But a Saint John-area nurse practitioner is bringing back the old-school approach for patients who can't get in to see a family doctor, can't or don't want to wait at the outpatient department, and aren't in an emergency situation.

Nurse practitioner Angela Gallagher is a certified cardiovascular nurse and diabetes educator. She's also working on a doctorate from the University of Massachusetts.

Since Gallagher founded Atlantic House Calls, a professional fee-for-service health-care practice last May, she gets a lot of calls for "things like sore throat, cough, cold, maybe a prescription renewal," she said.

"Things that oftentimes people wind up [getting treated] in the ER or an after-hours clinics, but which could easily be completed in a home setting."

Mobility issues, social anxiety

For patients who don't have access to a family physician, or who simply want to avoid long wait times, there's a lot that nurse practitioners can do, Gallagher said.

"Maybe they're on a medication that has been refilled numerous times at other places," she said, "but they haven't had the blood work done to monitor it. Maybe they're looking to monitor it, or having screening or testing done."

Some patients aren't able to leave their homes.

"It works well for people that have mobility issues," she said. "I've seen clients who have social anxiety who can't leave their homes and haven't had health care for three or four years. They're calling because they don't want to go out for whatever reason. It's private, and convenient."

At the same time, not every patient is a fit.

"I make sure that they're aware that there are other services: after-hours clinics, urgent care, and that there is a number to put your name on a list [to get a primary-care physician or NP]," she said. "It's about communicating the nurse practitioner's role, and what other services are out there."

The cost of a house call ranges from $75 on weekdays after hours, and $95 for a weekend visit. Clients in greater Saint John can book a visit on the phone, or online.

The service has been "very well-received," said Gallagher, who gets as many as eight calls a week.

"Clients that choose to have the service in their home are super grateful."

Already in other provinces

House call services have been gaining in popularity elsewhere in Canada.

In 2012, the Ontario government expanded funding to ensure that seniors and patients with mobility issues have access to house calls.

Gallagher was inspired to open the business after finding out about a similar service in St. John's, N.L.

She got in touch with a nurse practitioner offering the service there, "and it seemed like she was doing very well with it," Gallagher said. "I thought, 'why not try it here in New Brunswick?'"

She recently became an approved Medavie Blue Cross provider, which means patients with Blue Cross, veterans, and those covered under the Interim Federal Health Plan can get a portion of the house call fee reimbursed.

Her fee is paid by the patient, and New Brunswick Medicare doesn't cover any part of the service, she said.

But hopefully, Gallagher said, "this opens up a lot more coverage for people."

In New Brunswick, house calls from nurse practitioners have been slower to catch on because "the nurse practitioner movement is still fairly new," she said.

Similar to family physician

Some people aren't aware that a nurse practitioner is licensed to diagnose conditions, prescribe medications, order investigations and consult specialists.

To work privately, Gallagher secured approval from both the Nurses Association of New Brunswick and Horizon Health. Both have been "very excited and very supportive," she said.

She also has an agreement with a physician who is available if "there is something outside my scope of practice, which all NPs in New Brunswick have to have regardless," she said.

"[We are] very similar to a family physician," Gallagher said, "but we focus more on preventative health, wellness, education and making sure that we keep people well, safe and healthy."

She said she hopes founding Atlantic House Calls will highlight different funding models that are available to nurse practitioners. Even though they're trained to provide primary health care, they are are currently limited to working through regional health authorities.

"It is my hope that my business serves as a starting point for this conversation," she said.