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Behind the front door

The privilege of entering a family’s home, and the surprises that often accompany such a visit, used to be the province of primary care in the UK. Home visits for children are now rare, and out-of-hours care is seldom given by a general practitioner known to the family, so most GPs know nothing of a child beyond what presents in their consulting room. Yet we know that the home environment in relation to the management of long-term illness is highly significant. Increasingly, paediatricians based in the hospital and the community, including sub-specialists, recognise this and either visit families in person, or ensure that a member of the team does so.

In this issue Braken et al report the effects of home visits by specialist asthma nurses to children with problematical asthma. Every reader who has ever made a home visit will instantly concur with their statement that “... in many children information gained at the time of the home visit was invaluable in their overall assessment.” Indeed, reading between the lines and based on my own experience, the word ‘revelatory’ springs to mind. Their findings would apply just as much to other specialist outreach nurses. Where children’s responses to their treatments seem ‘problematical’ – doses are escalated, control seems poor – the …

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