有沟通问题与无沟通问题的老年人的照护者对养老院的偏好：离散选择实验。
Preference of caregivers on residential care homes for older persons with versus without communication problems: a discrete choice experiment.
机构信息
Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
Department of Applied Social Science, Hong Kong Polytechnic University, Hong Kong SAR, China.
出版信息
BMC Geriatr. 2022 May 10;22(1):411. doi: 10.1186/s12877-022-03073-9.
BACKGROUND
A residential care service voucher scheme has been introduced to expand the capacity and enhance choice of public-funded long-term care (LTC) in Hong Kong, enabling users to have greater choices over the types of LTC facilities. Older persons with communication problems have difficulties in understanding the care options available to them and expressing their preferences to care homes and daily service delivery, therefore hindering their ability to exercise control and choice. Thus, they may have different needs and preferences for the facilities than others due to their conditions. This study therefore aimed to investigate their preference for care homes in comparison with those without communication problems.
METHODS
A discrete choice experiment was conducted to elicit preference for six attributes derived from prior studies. The family caregivers of a random sample of older voucher holders were invited to undertake face-to-face interview. Willingness-to-pay (WTP) for the attributes was estimated for those with or without communication problems separately.
RESULTS
Two hundred eighty-three caregivers provided valid responses (74% response rate). Caregivers of those with communication problem preferred facilities operated by non-governmental organizations (WTP=HK$1777.4) and shorter travelling time (WTP=HK$1502.5 for <=0.5 hours), while those without the problem had greater preference for fewer roommates (WTP=HK$3048.1 for single room) and extra healthcare professionals (WTP=HK$1765.5). Heterogenous WTPs were identified from those with different income, marital status and caregivers' age.
CONCLUSIONS
The reputation, greater space and staff, and proximity/familiarity of the facilities were important for those with communication problems. To help meet these preferences, the facilities could establish collaborations with local community-based service providers and build their own outreach team to familiarize themselves with older persons. Additionally, household income and informal support availability should be considered for care planning.
背景
香港推行了安老院宿位券计划，以扩大公帑资助的长期护理服务的容量和选择，让使用者可选择更多不同类型的长期护理服务设施。有沟通问题的长者在理解可供选择的护理服务及向安老院和提供日常服务的机构表达喜好方面存在困难，从而妨碍他们行使控制权和选择权。因此，他们对设施的需求和喜好可能与其他人不同，这是由于他们的状况所致。本研究旨在调查他们对安老院的偏好与那些没有沟通问题的人的偏好有何不同。
方法
本研究采用离散选择实验，以从先前的研究中得出六个属性的偏好。从随机抽样的安老院宿位券持有人的家庭成员照顾者中邀请他们进行面对面访谈。分别为有或没有沟通问题的人士估算对这些属性的支付意愿。
结果
283 名照顾者提供了有效回复（74%的回复率）。有沟通问题的照顾者较偏好由非政府机构营运的设施（支付意愿=1777.4 港元）和较短的交通时间（<=0.5 小时的交通时间，支付意愿=1502.5 港元），而没有沟通问题的照顾者则较偏好较少室友（单人房，支付意愿=3048.1 港元）和额外的医疗保健专业人员（支付意愿=1765.5 港元）。从不同收入、婚姻状况和照顾者年龄的人士中识别出不同的支付意愿。
结论
对于有沟通问题的人来说，设施的声誉、更大的空间和员工以及设施的接近度/熟悉度都很重要。为了满足这些偏好，设施可以与当地社区服务提供商建立合作关系，并建立自己的外展团队，以便熟悉老年人。此外，应考虑家庭收入和非正式支持的可用性来进行护理计划。
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