Maastricht University, Alzheimer Centrum Limburg, NL, The Netherlands.
Nottingham University, Institute of Mental Health, Nottingham, UK.
Int J Geriatr Psychiatry. 2020 Jan;35(1):45-52. doi: 10.1002/gps.5213. Epub 2019 Nov 6.
In the current study, the Anderson model is used to determine equitable access to dementia care in Europe. Predisposing, enabling, and need variables were investigated to find out whether there is equitable access to dementia-specific formal care services. Results can identify which specific factors should be a target to improve access.
A total of 451 People with middle-stage dementia and their informal carers from eight European countries were included. At baseline, there was no use of formal care yet, but people were expected to start using formal care within the next year. Logistic regressions were carried out with one of four clusters of service use as dependent variables (home social care, home personal care, day care, admission). The independent variables (predisposing, enabling, and need variables) were added to the regression in blocks.
The most significant predictors for the different care clusters are disease severity, a higher sum of (un)met needs, hours spent on informal care, living alone, age, region of residence, and gender.
The Andersen model provided for this cohort the insight that (besides need factors) the predisposing variables region of residence, gender, and age do play a role in finding access to care. In addition, it showed us that the numbers of hours spent on informal care, living alone, needs, and disease severity are also important predictors within the model's framework. Health care professionals should pay attention to these predisposing factors to ensure that they do not become barriers for those in need for care.
本研究采用安德森模型评估欧洲痴呆症护理的公平性。研究调查了倾向因素、促成因素和需求变量，以了解是否能公平获得特定于痴呆症的正规护理服务。研究结果可明确应针对哪些具体因素来改善可及性。
共有来自 8 个欧洲国家的 451 名处于中期痴呆阶段的患者及其非正规照护者参与了本研究。在基线时，这些患者尚未使用正规护理，但预计在未来一年内将开始使用。采用 logistic 回归分析，将 4 个服务使用簇之一作为因变量（家庭社会护理、家庭个人护理、日托、入院）。将倾向性、促成性和需求变量按块添加到回归中。
不同护理簇的最显著预测因素为疾病严重程度、较高的（未满足）需求总和、非正规照护时间、独居、年龄、居住地区和性别。
对于该队列，安德森模型提供了一个见解，即（除了需求因素外），倾向因素，如居住地区、性别和年龄，在寻求护理方面也发挥了作用。此外，它还表明，非正规照护时间、独居、需求和疾病严重程度的数量也是模型框架内的重要预测因素。医疗保健专业人员应关注这些倾向性因素，以确保其不会成为有需要的患者获得护理的障碍。
