个体特征和市政特征对长期护理服务分配的影响：基于登记的横断面研究。
The influence of individual and municipality characteristics on allocation of long-term care services: a register-based cross-sectional study.
机构信息
Centre for Care Research, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway.
Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1‑3, Oslo, 0484, Norway.
出版信息
BMC Health Serv Res. 2023 Jul 27;23(1):801. doi: 10.1186/s12913-023-09641-y.
BACKGROUND
Variation in service allocation between municipalities may arise as a result of prioritisation. Both individual and societal characteristics determine service allocation, but previous literature has often investigated these factors separately. The present study aims to map variation in allocation of long-term care services and investigate the extent to which service allocation is associated with characteristics related to the individual care recipient and the municipality.
METHODS
This cross-sectional study used register data from the Norwegian Registry for Primary Health Care on all 250 687 individuals receiving municipal health and care services in Norway on 31 December 2019. These individual level data were paired with municipal level data from the Municipality-State-Reporting register and information on the care models in Norwegian long-term care services, derived from a nationwide survey. Multilevel analyses were used to identify individual and municipal factors that were associated with allocation of home care, practical assistance and long-term stay in institutions.
RESULTS
In total, 164 634 people received home care services and 97 380 received practical assistance per 31 December 2019. Furthermore, 64 404 received both types of home-based services and 31 342 people had a long-term stay in an institution. Increased disability was strongly associated with being allocated more hours of home care and practical assistance, as well as allocation of a long-term institutional stay. The amount of home care and practical assistance declined with increasing age, but the odds of institutional stay increased with age. Care recipients living alone received more home-based services, and women had higher odds of a long-term institutional stay. Significant associations between the proportion of elderly in nursing homes and allocation of a long-term institutional stay and more practical assistance emerged. Other associations with municipalities' structural characteristics and care service models were weak.
CONCLUSIONS
The influence of individual characteristics outweighed the contribution of municipality characteristics, and the results point to a limited influence of municipality characteristics on allocation of long-term care services.
背景
由于优先级的不同，各城市之间的服务分配可能会有所不同。个人和社会特征决定了服务分配，但以前的文献往往分别研究这些因素。本研究旨在绘制长期护理服务分配的变化图，并调查服务分配与与个人护理接受者和城市相关的特征之间的关联程度。
方法
本横断面研究使用了挪威初级卫生保健登记处的登记数据，该数据涵盖了截至 2019 年 12 月 31 日在挪威接受市卫生和保健服务的所有 250687 人。这些个体层面的数据与市-州报告登记处的城市层面数据以及全国调查中获得的挪威长期护理服务中护理模式的信息相匹配。多水平分析用于确定与家庭护理、实际援助和长期机构入住相关的个体和城市因素。
结果
截至 2019 年 12 月 31 日，共有 164634 人接受家庭护理服务，97380 人接受实际援助。此外，64404 人同时接受这两种家庭服务，31342 人长期入住机构。残疾程度增加与分配更多小时的家庭护理和实际援助以及分配长期机构入住高度相关。随着年龄的增长，家庭护理和实际援助的数量减少，但机构入住的几率增加。独居的护理接受者接受更多的家庭服务，而女性长期入住机构的几率更高。养老院中老年人的比例与长期机构入住和更多实际援助的分配之间存在显著关联。与城市结构特征和护理服务模式的其他关联较弱。
结论
个体特征的影响超过了城市特征的贡献，结果表明城市特征对长期护理服务分配的影响有限。
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