Centre on Aging & Department of Anthropology, University of Victoria, Victoria BC V8W 2Y2 Canada.
Health Soc Care Community. 2009 May;17(3):283-94. doi: 10.1111/j.1365-2524.2008.00830.x.
Healthcare policy reforms enacted through the 1990s explicitly endorsed expanded community care and enhanced equitable access to care. We examine end-of-life home-care service utilization during this time period. We are interested in trends in and predictors of utilization influencing receipt of service or total service use. This is a population-based, retrospective study of home-care utilization by adults 50 years of age and older in British Columbia, Canada, who died in the last 6 months of each year from 1991 to 2000 (n = 98,327). Data were drawn from the British Columbia Linked Health Data resource; we examined both receipt and extent of care, using logistic and standard regression models. Independent variables included year of death, age, gender, area of residence and income quintile. Year of death was not significantly associated with receipt of home care in general. However, the odds of receiving home support services declined significantly over time, while annual home support hours increased. In contrast, receipt of home nursing increased, while annual home nursing visits did not change. Social factors frequently emerged as significant predictors of both receipt and extent of care. However, we found only limited evidence for interactions between these factors and year of death acting as determinants of receipt or extent of service. Results suggest that end-of-life home care services did not expand, but instead were reallocated and intensified over the 1990s. As well, there was little evidence to suggest enhanced equity in access to care.
20 世纪 90 年代实施的医疗政策改革明确支持扩大社区护理，并增强了公平获得护理的机会。我们在此期间研究了临终家庭护理服务的使用情况。我们关注的是在此期间影响服务接受或总服务使用的利用趋势和预测因素。这是一项基于人群的回顾性研究，研究对象为不列颠哥伦比亚省 50 岁及以上的成年人，他们在 1991 年至 2000 年的每年最后 6 个月内死亡（n = 98,327）。数据来自不列颠哥伦比亚省关联健康数据资源；我们使用逻辑回归和标准回归模型检查了服务的接受程度和服务范围。自变量包括死亡年份、年龄、性别、居住地区和收入五分位数。死亡年份与一般家庭护理的接受情况并无显著关联。然而，接受家庭支持服务的可能性随着时间的推移显著下降，而每年的家庭支持时间却在增加。相比之下，接受家庭护理服务的比例增加，而每年的家庭护理就诊次数没有变化。社会因素经常成为服务接受程度和范围的重要预测因素。然而，我们只发现了这些因素与死亡年份之间的相互作用的有限证据，这些相互作用作为服务接受或范围的决定因素。研究结果表明，临终家庭护理服务并没有扩大，而是在 20 世纪 90 年代进行了重新分配和强化。此外，几乎没有证据表明在获得护理方面的公平性得到了提高。
