Bravo G, Dubois M F, Charpentier M, De Wals P, Emond A
Département des sciences de la santé communautaire, Faculté de médecine, Université de Sherbrooke, Que.
CMAJ. 1999 May 18;160(10):1441-5.
The recent proliferation of unlicensed homes for the aged in Quebec, coupled with the increased needs of the population they serve, has raised concerns about the quality of case these homes provide. The authors compared the quality of care in unlicensed homes with that in licensed long-term care facilities in a region of Quebec.
The study involved 301 impaired people aged 65 and over in 88 residential care facilities (52 unlicensed, 36 licensed) in the Eastern Townships of Quebec. Study participants were chosen according to a 2-stage sampling scheme: stratified sampling of the primary units (facilities) and random sampling of the secondary units (residents). Quality of care was measured using the QUALCARE scale, a multidimensional instrument that uses a 5-point scale to assess 6 dimensions of care: environmental, physical, medical management, psychosocial, human rights and financial. A mean score of more than 2 was considered indicative of inadequate care.
Overall, the quality of care was similar in the unlicensed and licensed facilities (mean global score 1.61 [standard error of the mean (SEM) 0.06] and 1.47 [SEM 0.09] respectively). Examination of dimension-specific quality-of-care scores revealed that the unlicensed homes performed worse than the licensed facilities in 2 areas of care: physical care (mean score 1.80 [SEM 0.08] v. 1.51 [SEM 0.09] respectively, p = 0.017) and medical management (1.37 [SEM 0.06] v. 1.14 [SEM 0.05], p = 0.004). The dimension-specific scores also revealed that both types of homes lacked appropriate attention to the psychosocial aspect of care. Overall, 25% of the facilities provided inadequate care to at least one resident. This situation was especially prevalent among homes with fewer than 40 residents, where up to 20% of the residents received inadequate care.
Most of the unlicensed homes for the aged that were studied delivered care of relatively good quality. However, some clearly provided inadequate care.
近期魁北克无证老年之家数量激增，再加上其所服务人群需求的增加，引发了人们对这些机构所提供护理质量的担忧。作者比较了魁北克某地区无证老年之家与有执照的长期护理机构的护理质量。
该研究涉及魁北克东部乡镇88家住宿护理机构（52家无证，36家有执照）中的301名65岁及以上的残障人士。研究参与者是根据两阶段抽样方案选取的：对主要单位（机构）进行分层抽样，对次要单位（居民）进行随机抽样。使用QUALCARE量表来衡量护理质量，这是一种多维工具，采用5分制来评估护理的6个维度：环境、身体、医疗管理、心理社会、人权和财务。平均分超过2分被认为表明护理不足。
总体而言，无证机构和有执照机构的护理质量相似（总体平均得分分别为1.61[平均标准误差（SEM）0.06]和1.47[SEM 0.09]）。对特定维度护理质量得分的检查显示，无证老年之家在两个护理领域的表现比有执照机构差：身体护理（平均得分分别为1.80[SEM 0.08]和1.51[SEM 0.09]，p = 0.017）和医疗管理（1.37[SEM 0.06]和1.14[SEM 0.05]，p = 0.004）。特定维度得分还显示，两种类型的机构都对护理的心理社会方面缺乏适当关注。总体而言，25%的机构至少对一名居民提供了不足的护理。这种情况在居民少于40人的机构中尤为普遍，其中高达20%的居民接受了不足的护理。
大多数被研究的无证老年之家提供了质量相对较好的护理。然而，有些机构显然提供了不足的护理。
