Department of Public Health, Università Cattolica Sacro Cuore, Rome, Italy.
BMC Health Serv Res. 2009 Sep 24;9:174. doi: 10.1186/1472-6963-9-174.
The ageing population in Europe is putting an ever increasing demand on the long-term care (LTC) services provided by these countries. This study analyses the relationship between the LTC institutional supply of beds and potential care needs, taking into account the social and health context, the supply of complementary and alternative services, along with informal care.
An observational, cross-sectional, ecological study was carried out. Statistical data were obtained from the Italian National Institute of Statistics and Ministry of Health. Indicators, regarding 5 areas (Supply of beds in long term care institutions, Potential care needs, Social and health context, Complementary and alternative services for the elderly, Informal care), were calculated at Local Health Unit (LHU) level and referred to 2004.Two indicators were specifically used to measure supply of beds in long term care institutions and potential care needs for the elderly. Their values were grouped in tertiles. LHU were classified according to the combination of tertiles in three groups: A. High level of supply of beds in long term care institutions associated with low level of potential care needs; B. Low level of supply of beds in long term care institutions associated with high level of potential care needs; C. Balanced level of supply of beds in long term care institutions with potential care needs. For each group the indicators of 5 areas were analysed.The Index Number (IN) was calculated for each of these indicators.
Specific factors that need to be carefully considered were highlighted in each of the three defined groups. The highest level of alternative services such as long-stay hospital discharges in residence region (IN = 125), home care recipients (HCR) (IN = 123.8) were reported for Group A. This group included North regions. The highest level of inappropriate hospital discharges in (IN = 124.1) and out (IN = 155.8) the residence region, the highest value of families who received help (IN = 106.4) and the lowest level of HCR (IN = 68.7) were found in Group B. South regions belong to this group. The highest level of families paying a caregiver (IN = 115.8) was shown in Group C. Central regions are included in third group.
Supply of beds in long term care institutions substantially differs across Italian regions, showing in every scenario some imbalances between potential care needs and other studied factors. Our study suggests the need of a comprehensive rethinking of care delivery "system".
欧洲人口老龄化使得这些国家对长期护理（LTC）服务的需求不断增加。本研究分析了考虑到社会和卫生背景、补充和替代服务的供应以及非正式护理后，LTC 机构床位供应与潜在护理需求之间的关系。
本研究采用观察性、横断面、生态学研究方法。统计数据来自意大利国家统计局和卫生部。以 2004 年为基准，在地方卫生单位（LHU）水平上计算了 5 个领域（长期护理机构床位供应、潜在护理需求、社会和卫生背景、老年人补充和替代服务、非正式护理）的指标。特别使用了两个指标来衡量长期护理机构的床位供应和老年人的潜在护理需求。其值分为三分位数。根据三分位数的组合，LHU 被分为三组：A. 长期护理机构床位供应水平高，潜在护理需求水平低；B. 长期护理机构床位供应水平低，潜在护理需求水平高；C. 长期护理机构床位供应与潜在护理需求平衡。对每组的 5 个领域的指标进行了分析。为这些指标中的每一个计算了指数数（IN）。
在这三组中，都突出了需要仔细考虑的具体因素。A 组报告了替代服务的最高水平，如长期住院患者在居住地区的出院（IN = 125）、家庭护理接受者（HCR）（IN = 123.8），包括北部地区。B 组报告了最不合理的医院出院（IN = 124.1）和出院（IN = 155.8），家庭接受帮助的最高水平（IN = 106.4）和 HCR 的最低水平（IN = 68.7），包括南部地区。C 组报告了家庭支付护理人员最高水平（IN = 115.8），包括中部地区。
意大利各地区的长期护理机构床位供应差异很大，在每个场景中都显示出潜在护理需求与其他研究因素之间存在一些不平衡。我们的研究表明，有必要对护理服务的“系统”进行全面重新思考。
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