Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Canadian Center for Health Economics, Toronto, Ontario, Canada.
Health Soc Care Community. 2019 Mar;27(2):437-448. doi: 10.1111/hsc.12664. Epub 2018 Oct 11.
Understanding how informal care impacts formal care utilisation for home-based end-of-life patients is an important policy- and practice-relevant question. This paper aims to assess the relationship between informal and formal home care among home-based end-of-life patients and how this relationship has changed over the last decade and over the end-of-life trajectory. We focus on informal care provided by family members or friends, and three types of home-based formal care services: care by personal support workers, physician visits, and nurse visits. Using survey data collected in a home-based end-of-life care programme in Ontario, Canada from 2005 to 2016, we build a two-part utilisation model analysing both the propensity to use each type of formal care and the amount of formal care received by patients. The results suggest that informal care is a substitute for care by personal support workers, but a complement to physician visits and nurse visits. In the case of nurse visits, an increased complementary effect is observed in more recent years. For home-based physician and nurse visits, the complementary effect grows with patient's proximity to death. These results highlight the complexity of the relationship between informal and formal care among home-based end-of-life patients. Decision-makers need to take into account the relationship between informal care and different types of formal services when introducing future policies.
了解非正规护理如何影响居家临终患者的正规护理利用，是一个具有重要政策和实践相关性的问题。本文旨在评估居家临终患者的非正规家庭护理和正规家庭护理之间的关系，以及这种关系在过去十年和临终过程中是如何变化的。我们关注的是家庭成员或朋友提供的非正式护理，以及三种类型的居家正规护理服务：个人支持工作者护理、医生访视和护士访视。我们使用了加拿大安大略省一个居家临终关怀项目在 2005 年至 2016 年期间收集的调查数据，构建了一个两部分的利用模型，分析了每种类型的正规护理的使用倾向以及患者接受的正规护理量。结果表明，非正式护理是个人支持工作者护理的替代品，但与医生访视和护士访视相辅相成。在护士访视方面，近年来观察到互补效应增加。对于居家医生和护士访视，随着患者接近死亡，互补效应会增强。这些结果突出了居家临终患者非正规和正规护理之间关系的复杂性。决策者在引入未来政策时，需要考虑非正式护理与不同类型正规服务之间的关系。
