Department of Health Care Administration, Chang Jung Christian University, No. 396, Sec. 1, Changrong Rd., Tainan, Taiwan.
Health Policy. 2009 Dec;93(2-3):137-42. doi: 10.1016/j.healthpol.2009.07.005. Epub 2009 Aug 7.
To investigate the emergency room (ER) utilization among disabled Taiwanese older adults with different patterns of care arrangement.
A national probability sample of 13,957 disabled older adults (aged 50 and above) was recruited. Individual interview data and National Health Insurance administrative data were used to examine the effects of care arrangements on ER utilization 1 year after the baseline interview.
One-third (33.5%) of the subjects used emergency room at least once in the follow-up year. The ER utilization rates among individuals living in institutions, in home with foreigner worker, in home with informal caregiver, and in home without caregiver, were 34.5%, 43%, 32.5% and 25% respectively. After controlling for other predisposing, enabling, need factors, and healthcare services use with multivariate logistic regression model, comparing with subjects staying home with informal caregivers, those who were institutionalized were less likely to use ER services during the study year (OR=0.64, 95%CI=0.54-0.76), those who staying home cared by foreigner worker were more likely to use ER services (OR=1.16, 95%CI=1.05-1.29), and those who staying home without caregiver were less likely to use ER services (OR=0.89, 95%CI=0.78-1.01).
Disabled older adults staying at home were more likely to use ER compared to institutionalized individuals. More research is needed to identify the unmet healthcare needs and the quality of home care that may explain the high ER utilization rate.
调查不同照料安排模式下残疾台湾老年患者在急诊室的就诊情况。
本研究使用全国概率抽样方法招募了 13957 名残疾老年人（年龄在 50 岁及以上）。使用个体访谈数据和全民健康保险管理数据，考察了照料安排对基线访谈后 1 年的急诊室就诊的影响。
三分之一（33.5%）的患者在随访年内至少使用过一次急诊室。居住在机构、家中有外籍工人、家中有非正式照料者和家中无照料者的患者急诊室就诊率分别为 34.5%、43%、32.5%和 25%。使用多变量逻辑回归模型控制其他倾向因素、促成因素、需要因素和医疗保健服务使用情况后，与家中有非正式照料者的患者相比，居住在机构中的患者在研究年内使用急诊室服务的可能性较小（OR=0.64，95%CI=0.54-0.76），家中有外籍工人照料的患者更有可能使用急诊室服务（OR=1.16，95%CI=1.05-1.29），而家中无照料者的患者使用急诊室服务的可能性较小（OR=0.89，95%CI=0.78-1.01）。
与居住在机构中的患者相比，居住在家中的残疾老年人更有可能使用急诊室。需要更多的研究来确定未满足的医疗保健需求和家庭护理质量，这可能解释了高急诊室就诊率的原因。
