Page Jude, Comino Elizabeth, Burgess Mandy, Cullen John, Harris Elizabeth
Health Equity Research and Development Unit, Sydney Local Health District, PO Box 374, Camperdown, NSW 2050, Australia.
Centre for Primary Health Care and Equity, Faculty of Medicine, UNSW Sydney, Sydney, NSW 2052, Australia. Email:.
Aust Health Rev. 2018 Sep;42(5):557-562. doi: 10.1071/AH18117.
Objective The aim of this study was to identify whether the Hospital in the Home (HITH) program was taken up equitably by eligible patients in relation to their age, sex, country of birth, place of residence and primary diagnosis. Methods This study presents results of a descriptive analysis of the administrative records of 3552 people with specific conditions who met the study criteria of potential eligibility to HITH and resided within the health district boundary. Results Systematic differences were found for participation in HITH and in-patient care according to sex, language spoken at home and socioeconomic status based on place of residence. This suggests that people from higher socioeconomic backgrounds who speak English at home were more likely to participate in and benefit from HITH. Tailored interventions were identified as a potential way to reduce the gap in access to quality health care for women and people who speak a language other than English at home. If HITH is the optimum treatment available, then these differences could be considered potentially avoidable and unfair. Conclusion Data analysis through an equity lens can effectively identify who is accessing health services and who is missing out. Further analysis is required to understand patient and system barriers to accessing HITH. What is known about the topic? Advances in medical and surgical treatments and pharmaceuticals reduce the need for in-patient hospitalisation. For some conditions, home-based treatment is safer, cheaper and preferable to the patient and carers, particularly some older people who may experience deteriorating cognitive and physical functioning related to hospitalisation. It is well known that health and access to health care is not equally distributed in society. What does this paper add? This study represents the first effort to quantitatively evaluate differences in patterns of participation in HITH related to socioeconomic and language characteristics. There are underutilised opportunities for improved participation in HITH by identifying who is not accessing programs at a comparable rate and therefore not benefitting from optimal health services. By exploring why this may be occurring at an individual and system level, we can be more informed to address these reasons and achieve better health and social outcomes. What are the implications for practitioners? It is important to consider both consumer and service provider views in shaping current and future service models. Comprehensive assessment of support needs to participate in HITH for patients and carers, as well as communicating potential benefits in ways patients understand, can improve participation and satisfaction, reduce health costs and improve health outcomes.
目的 本研究旨在确定居家医院（HITH）项目在符合条件的患者中，是否依据其年龄、性别、出生国家、居住地点及主要诊断实现了公平参与。方法 本研究对3552名患有特定疾病且符合HITH潜在资格研究标准并居住在健康区边界内的人员的行政记录进行了描述性分析，并呈现结果。结果 发现根据性别、在家中使用的语言以及基于居住地点的社会经济地位，在参与HITH和住院治疗方面存在系统性差异。这表明来自社会经济背景较高且在家中说英语的人更有可能参与HITH并从中受益。针对性干预被确定为缩小女性和在家中说英语以外语言的人在获得优质医疗保健方面差距的一种潜在方式。如果HITH是可用的最佳治疗方法，那么这些差异可能被认为是潜在可避免和不公平的。结论 通过公平视角进行数据分析可以有效识别谁在使用医疗服务以及谁被遗漏。需要进一步分析以了解患者和系统在获取HITH方面的障碍。关于该主题已知的信息有哪些？医学和外科治疗以及药物的进步减少了住院需求。对于某些疾病，居家治疗对患者和护理人员来说更安全、更便宜且更可取，特别是一些可能因住院而出现认知和身体功能恶化的老年人。众所周知，健康和获得医疗保健的机会在社会中分布不均。本文补充了什么？本研究是首次对与社会经济和语言特征相关的HITH参与模式差异进行定量评估。通过确定谁没有以可比比率参与项目，从而没有从最佳医疗服务中受益，存在未充分利用的提高HITH参与度的机会。通过在个人和系统层面探索这可能发生的原因，我们可以更明智地解决这些原因，并实现更好的健康和社会成果。对从业者有哪些启示？在塑造当前和未来服务模式时，考虑消费者和服务提供者的观点很重要。对患者和护理人员参与HITH的支持需求进行全面评估，以及以患者理解的方式传达潜在益处，可以提高参与度和满意度，降低医疗成本并改善健康结果。
