吸收性产品分配系统对意大利失禁老年人家庭照顾者的影响：对所获得支持的感知。
The impact of the absorbent products distribution system on family caregivers of older people with incontinence in Italy: perception of the support received.
机构信息
IRCCS INRCA - National Institute of Health and Science on Ageing, Centre for Socio-Economic Research on Ageing, Via S. Margherita 5, 60124, Ancona, Italy.
Unit of Geriatric Pharmacoepidemiology, IRCCS INRCA - National Institute of Health and Science on Ageing, Contrada Muoio Piccolo, 87100, Cosenza, Italy.
出版信息
BMC Geriatr. 2019 Aug 29;19(1):239. doi: 10.1186/s12877-019-1254-4.
BACKGROUND
Urinary incontinence is a chronic, age-related disorder, likely to increase in the future due to global population ageing. In Italy, as in most countries, older people with incontinence are often cared for by family caregivers, whose burden might be worsened by the perception of receiving an inadequate support, due to the lack of customized services. The aim of this study was to evaluate the impact of the absorbent products distribution method on family caregivers' perception of the support received.
METHODS
The study compared the distribution of pads to homes and in pharmacy via a survey reaching 101 family caregivers of older people with incontinence living in two geographical areas of the Marche Region (Central Italy) with different distribution systems. The association between "Quality of perceived support" (the outcome variable) and two types of absorbent products delivery methods (i.e. pharmacy and home distribution) was analysed by means of a general linear model.
RESULTS
Findings show that family caregivers receiving pads at home (HODs) perceived a higher support than those gaining them at the pharmacy (PHADs) (respectively 68.1% vs 35%). The association between perceived support level and distribution system remained even after correction for confounding factors. 70.2% of PHADs reported "Poor well-being", versus only 53.7% of HODs. The latter are more satisfied with the type of products distribution and thus less inclined to experiment different systems for the supply of products for the urinary continence (e.g. by voucher). The results are virtually reversed among PHADs and the difference is statistically significant (p < 0.001).
CONCLUSIONS
When family caregivers feel supported by a more customized service delivery system, their perception of the care-related burden is mitigated. Thus, it is important to consider the needs of both family caregivers and cared for older people, and not only of the latter for designing a more suitable distribution of absorbent products. The best solution could be leaving end-users the freedom to choose how they want to get products (e.g. voucher or personal budget). This requires a reorganization of the current pads delivery systems adopted by the Marche and by other Italian Regional Health Systems.
背景
尿失禁是一种慢性的、与年龄相关的疾病，由于全球人口老龄化，未来这种疾病的发病率可能会上升。在意大利，与大多数国家一样，有尿失禁的老年人通常由家庭护理人员照顾，由于缺乏定制化服务，他们可能会因为感到没有得到足够的支持而增加负担。本研究旨在评估吸收性产品分配方法对家庭护理人员所获得支持的感知的影响。
方法
该研究通过一项调查比较了两种不同的区域分配系统，对居住在意大利马尔凯大区（意大利中部）两个不同地理区域的、有尿失禁的老年人家属护理者进行了 101 例调查，以评估护垫分配到家和分配到药店两种方法对家庭护理者的影响。使用一般线性模型分析“感知到的支持质量”（因变量）与两种吸收性产品交付方法（即药店和家庭分配）之间的关联。
结果
研究结果表明，在家中获得护垫的家庭护理者（HODs）比在药店获得护垫的家庭护理者（PHADs）（分别为 68.1%和 35%）感知到更高的支持。在纠正混杂因素后，感知到的支持水平与分配系统之间的关联仍然存在。70.2%的 PHADs 报告“健康状况不佳”，而 HODs 中只有 53.7%。后者对产品分配类型更满意，因此不太倾向于尝试不同的产品供应系统（例如，通过代金券）。这种结果在 PHADs 中几乎相反，差异具有统计学意义（p<0.001）。
结论
当家庭护理者感到服务提供系统更具个性化时，他们对相关护理负担的感知就会减轻。因此，在设计更适合的吸收性产品分配方案时，不仅要考虑老年患者的需求，还要考虑家庭护理者的需求。对于最终用户而言，选择他们想要获得产品的方式（例如代金券或个人预算）是很重要的。这需要对马尔凯大区和意大利其他地区卫生系统目前采用的护垫配送系统进行重新组织。
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