年龄、性别与多种疾病并存水平和接受家庭医疗保健之间的关联：一项基于瑞典人群的研究。
Association between age, gender and multimorbidity level and receiving home health care: a population-based Swedish study.
作者信息
Zielinski Andrzej, Halling Anders
机构信息
Lyckeby Primary Healthcare Centre and Blekinge Centre of Competence, Källevägen 12, 371 62, Lyckeby, Sweden.
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9a, 5000, Odense, Denmark.
出版信息
BMC Res Notes. 2015 Nov 24;8:714. doi: 10.1186/s13104-015-1699-2.
BACKGROUND
Home health care is an important part of primary health care. How delivery of home health care is organised is probably important for sustainability of the healthcare system as a whole. More than 50 % of individuals over 65 years old have multimorbidity, which increases with higher age, also influencing the needs of home health care. Our aim was to study the proportion of the population above 65 years receiving home health care according to age, gender and multimorbidity level.
METHODS
The study population comprised 32,130 people aged 65 or more, living in Blekinge County in southern Sweden. We analysed data from patient electronic medical records for patients receiving home health care delivered in patients' own homes by nurses, physiotherapists and occupational therapists. We used the Adjusted Clinical Groups Case-Mix System in order to group individuals according to diagnoses into six levels of multimorbidity. In order to analyse the differences between individuals receiving home health care and those who did not, we used Chi squared test. Logistic regression analysis was conducted in order to study how the dependent variable was influenced by the independent variables.
RESULTS
A total of 7860 (28 %) of the studied population received home health care in 2011. Logistic regression analysis showed that men had 26 % lower odds of receiving home care compared to women (OR = 0.74, 95 % CI 0.69-0.78). There was also a substantial group (22 %) with low multimorbidity level among people receiving home health care. Adjusting for gender and age showed no differences in odds of receiving home health care for patients with lower levels of multimorbidity. However, for patients with higher levels of morbidity the odds increased dramatically for both genders.
CONCLUSION
The question of to whom and to what extent home health care should be provided is an important challenge for policy makers. Our results show that there are differences in the use of home health care dependent on gender, age and multimorbidity level, but also that home health care is provided to individuals with low morbidity. Further studies could explain the factors influencing home health care use.
背景
居家医疗保健是初级医疗保健的重要组成部分。居家医疗保健的组织方式可能对整个医疗保健系统的可持续性至关重要。超过50%的65岁以上人群患有多种疾病，且随着年龄增长患病率增加，这也影响了居家医疗保健的需求。我们的目的是研究65岁以上人群中根据年龄、性别和多种疾病水平接受居家医疗保健的比例。
方法
研究人群包括居住在瑞典南部布莱金厄省的32130名65岁及以上的人。我们分析了护士、物理治疗师和职业治疗师在患者家中提供居家医疗保健的患者的电子病历数据。我们使用调整后的临床分组病例组合系统，以便根据诊断将个体分为六个多种疾病水平组。为了分析接受居家医疗保健的个体与未接受者之间的差异，我们使用了卡方检验。进行逻辑回归分析以研究自变量如何影响因变量。
结果
2011年，共有7860名（28%）研究人群接受了居家医疗保健。逻辑回归分析表明，与女性相比，男性接受居家护理的几率低26%（OR = 0.74，95% CI 0.69 - 0.78）。在接受居家医疗保健的人群中，也有相当一部分（22%）多种疾病水平较低。调整性别和年龄后，多种疾病水平较低的患者接受居家医疗保健几率没有差异。然而，对于发病率较高的患者，两性的几率都大幅增加。
结论
应该向谁以及在多大程度上提供居家医疗保健的问题是政策制定者面临的一项重要挑战。我们的结果表明，居家医疗保健的使用因性别、年龄和多种疾病水平而异，但也表明低发病率个体也能获得居家医疗保健。进一步的研究可以解释影响居家医疗保健使用的因素。
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