Ravensbergen W M, Drewes Y M, Hilderink H B M, Verschuuren M, Gussekloo J, Vonk R A A
Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands.
Department of Internal medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands.
Health Policy. 2019 Oct;123(10):947-954. doi: 10.1016/j.healthpol.2019.07.002. Epub 2019 Jul 17.
To explore the combined effect of trends in older people on their future healthcare utilisation.
A Delphi study consisting of two rounds was conducted. The heterogeneous expert panel (n = 16) in the field of elderly care rated the effect of combinations of trends in the Netherlands on the use of seven healthcare services: i.e. informal, home, general practitioner, acute, specialist, nursing home and mental health care. The percentage and direction of the overall consensus, for the different health services, and for three main trends were analysed.
Experts reached consensus in 57 of 92 ratings (62%). Taking into account the interaction between trends, they expected an extra increase for informal, home, and general practitioner care, but no additional effect of interaction for specialist and acute care. Combinations that included trends leading to less support were expected to lead to an extra increase in utilisation.
Experts expect that interaction between trends will lead to an extra increase in the use of general practitioner, home, and informal care. This increase is mainly the result of interaction with trends leading to less support for older persons. The present results show the need to take the effect of interaction into account when designing new health policy and in research on future healthcare utilisation.
探讨老年人趋势对其未来医疗保健利用的综合影响。
开展了一项包括两轮的德尔菲研究。老年护理领域的异质性专家小组（n = 16）对荷兰各种趋势组合对七种医疗服务使用情况的影响进行了评分，这七种医疗服务分别是：非正式护理、居家护理、全科医生护理、急症护理、专科护理、养老院护理和精神卫生护理。分析了不同医疗服务以及三种主要趋势的总体共识的百分比和方向。
专家们在92项评分中的57项（62%）达成了共识。考虑到趋势之间的相互作用，他们预计非正式护理、居家护理和全科医生护理会额外增加，但专科护理和急症护理的相互作用没有额外影响。预计包含导致支持减少趋势的组合会使利用率额外增加。
专家们预计趋势之间的相互作用将导致全科医生护理、居家护理和非正式护理的使用额外增加。这种增加主要是与导致对老年人支持减少的趋势相互作用的结果。目前的结果表明，在设计新的卫生政策以及未来医疗保健利用研究中，需要考虑相互作用的影响。
