近期出院的老年人的健康与社会支持服务：服务利用情况、成本及家庭锻炼干预影响的探索
Health and social support services in older adults recently discharged from hospital: service utilisation and costs and exploration of the impact of a home-exercise intervention.
作者信息
Farag I, Howard K, O'Rourke S, Ferreira M L, Lord S R, Close J C T, Vogler C, Dean C M, Cumming R G, Sherrington C
机构信息
The George Institute for Global Health, Musculoskeletal Division, Sydney Medical School, The University of Sydney, Level 13, 321 Kent Street, Sydney, NSW, 2000, Australia.
Institute for Choice, University of South Australia, North Sydney, NSW, 2060, Australia.
出版信息
BMC Geriatr. 2016 Apr 18;16:82. doi: 10.1186/s12877-016-0254-x.
BACKGROUND
Admission to hospital can lead to persistent deterioration in physical functioning, particularly for the more vulnerable older population. As a result of this physical deterioration, older people who have been recently discharged from hospital may be particularly high users of health and social support services. Quantify usage and costs of services in older adults after hospitalisation and explore the impact of a home-exercise intervention on service usage.
METHOD
The present study was a secondary analysis of data from a randomised controlled trial (ACTRN12607000563460). The trial involved 340 participants aged 60 years and over with recent hospitalisation. Service use and costs were compared between intervention (12 months of home-exercise prescribed in 10 visits from a physiotherapist) and control groups.
RESULTS
33 % of participants were re-admitted to hospital, 100 % consulted a General Medical Practitioner and 63 % used social services. 56 % of costs were associated with hospital admission and 22 % with social services. There was reduction in General Medical Practitioner services provided in the home in the intervention group (IRR 0.23, CI 0.1 to 0.545, p < 0.01) but no significant between-group difference in service use or in costs for other service categories.
CONCLUSION
There appears to be substantial hospital and social service use and costs in this population of older people. No significant impact of a home-based exercise program was evident on service use or costs.
TRIAL REGISTRATION
Australian and New Zealand Clinical Trial Registry ACTRN12607000563460 >TrialSearch.
背景
住院可能导致身体机能持续恶化，尤其是对较为脆弱的老年人群体而言。由于这种身体机能的衰退，刚出院的老年人可能会成为健康和社会支持服务的高使用人群。量化老年人住院后的服务使用情况和成本，并探讨家庭锻炼干预对服务使用的影响。
方法
本研究是对一项随机对照试验（澳大利亚和新西兰临床试验注册号：ACTRN12607000563460）数据的二次分析。该试验纳入了340名60岁及以上近期住院的参与者。比较了干预组（由物理治疗师进行10次家访并开具为期12个月的家庭锻炼处方）和对照组的服务使用情况及成本。
结果
33%的参与者再次住院，100%咨询过全科医生，63%使用过社会服务。56%的成本与住院相关，22%与社会服务相关。干预组家庭中全科医生提供的服务有所减少（发生率比0.23，可信区间0.1至0.545，p<0.01），但在服务使用或其他服务类别的成本方面，组间无显著差异。
结论
这群老年人的医院和社会服务使用情况及成本似乎都很高。基于家庭的锻炼计划对服务使用或成本没有明显的显著影响。
试验注册
澳大利亚和新西兰临床试验注册中心ACTRN12607000563460>TrialSearch。
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