Department of Health Services Research, faculty of medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba Ibaraki, 305-8575, Japan.
BMC Geriatr. 2013 Jan 2;13:1. doi: 10.1186/1471-2318-13-1.
In Japan, there is a large increase in the number of elderly persons who potentially need home-visit nursing services (VNS). However, the number of persons using the VNS has increased only little in comparison to the number of individuals who use home social services, which are also covered by the Long-Term Care Insurance (LTCI) system. This cross-sectional study investigated the predictors of the VNS used under the LTCI system in Japan.
We used 1,580 claim data from all the users of community-based services and 1,574 interview survey data collected in 2001 from the six municipal bodies in Japan. After we merged the two datasets, 1,276 users of community-based services under the LTCI were analyzed. Multiple logistic regression models stratified by care needs levels were used for analysis.
Only 8.3% of the study subjects were VNS users. Even among study participants within the higher care-needs level, only 22.0% were VNS users. In the lower care level group, people with a higher care level (OR: 3.50, 95% CI: 1.50-8.93), those whose condition needed long term care due to respiratory or heart disease (OR: 4.31, 95% CI: 1.88-89.20), those whose period of needing care was two years or more (OR: 2.01, 95% CI: 1.14-3.48), those whose service plan was created by a medical care management agency (OR: 2.39, 95% CI: 1.31-4.33), those living with family (OR: 1.86, 95% CI: 1.00-3.42), and those who use home-help services (OR: 2.12, 95% CI: 1.17-3.83) were more likely to use the VNS. In the higher care level group, individuals with higher care level (OR: 3.63, 95% CI: 1.56-8.66), those with higher income (OR: 3.79, 95% CI: 1.01-14.25), and those who had regular hospital visits before entering the LTCI (OR: 2.36, 95% CI: 1.11-5.38) were more likely to use the VNS.
Our results suggested that VNS use is limited due to management by non-medical care management agencies, due to no caregivers being around or a low income household. The findings of this study provide valuable insight for LTCI policy makers: the present provision of VNS should be reconsidered.
在日本，需要上门护理服务（VNS）的老年人数量大幅增加。然而，与使用家庭社会服务的人数相比，使用 VNS 的人数增加很少，而家庭社会服务也属于长期护理保险（LTCI）系统的覆盖范围。本横断面研究调查了日本 LTCI 系统下使用 VNS 的预测因素。
我们使用了来自日本六个市的所有社区服务使用者的 1580 份索赔数据和 2001 年收集的 1574 份访谈调查数据。在合并了这两个数据集后，分析了 1276 名社区服务 LTCI 使用者。按护理需求水平分层的多变量逻辑回归模型用于分析。
只有 8.3%的研究对象是 VNS 用户。即使在护理需求水平较高的研究参与者中，也只有 22.0%的人使用 VNS。在较低的护理水平组中，护理水平较高的人（OR：3.50，95%CI：1.50-8.93）、因呼吸或心脏疾病需要长期护理的人（OR：4.31，95%CI：1.88-89.20）、护理期为两年或以上的人（OR：2.01，95%CI：1.14-3.48）、其服务计划由医疗管理机构制定的人（OR：2.39，95%CI：1.31-4.33）、与家人同住的人（OR：1.86，95%CI：1.00-3.42）和使用家庭帮助服务的人（OR：2.12，95%CI：1.17-3.83）更有可能使用 VNS。在较高护理水平组中，护理水平较高的人（OR：3.63，95%CI：1.56-8.66）、收入较高的人（OR：3.79，95%CI：1.01-14.25）和在进入 LTCI 前定期住院的人（OR：2.36，95%CI：1.11-5.38）更有可能使用 VNS。
我们的结果表明，由于非医疗管理机构管理、没有照顾者或家庭收入低，VNS 的使用受到限制。本研究的结果为 LTCI 政策制定者提供了有价值的见解：目前应重新考虑 VNS 的提供。
