Section of Epidemiology, Shizuoka Graduate University of Public Health, 4-27-2 Aoi-ku, Kita-ando, Shizuoka-shi, Shizuoka, 420-0881, Japan.
Department of Health Informatics, Graduate School of Medicine & School of Public Health, Kyoto University, Yoshidakonoe-cho, Sakyou-ku, Kyoto, Kyoto, 606-8501, Japan.
BMC Health Serv Res. 2023 Oct 2;23(1):1053. doi: 10.1186/s12913-023-09990-8.
Swallowing/feeding difficulty is a serious hidden health problem in the older population. Although oral intake services based on the degree of this difficulty have been provided and revised in Japanese public long-term care (LTC) insurance since 2006, their implementation has not been examined. We evaluated the impact of policy changes on these services.
The nationwide database of LTC service uses in Japan was analysed for three oral intake services: Enhanced Oral Function in daycare facilities whose users were slightly disabled, Maintenance of Oral Ingestion and Transition to Oral Ingestion from tube feeding in residential facilities. Data were extracted for each June from 2015 to 2020 when monthly usage of these services was aligned and each June from 2009 to 2020 for the proportion of users according to LTC insurance certification. The major policy changes were the addition of municipal provision in Enhanced Oral Function and a requirement for multidisciplinary collaboration in Maintenance of Oral Ingestion in 2015. The impact of the medical fee reduction for developing percutaneous gastro-tubing to Transition to Oral Ingestion was also examined.
Between 2015 and 2020, the use of Enhanced Oral Function and Maintenance of Oral Ingestion increased and Transition to Oral Ingestion decreased, resulting in a total increase in use of 275,000 times or approximately 5,000 times per 100,000 among all older adults with LTC insurance certification. Concerning the proportion of users' disability status, the major users of Enhanced Oral Function in 2020 were slightly disabled and independent older adults (70%, up from 55% to 2009). Regarding the major users of Maintenance of Oral Ingestion between 2013 and 2020, care-need level 5 (most severe) decreased by 11%, whereas the total of care-need levels 4 and 3 increased by 9%. The use of Transition to Oral Ingestion, which had been declining, showed a further decline after reduction of the medical fee for percutaneous gastro-tubing in 2014.
Due to policy changes, Enhanced Oral Function and Maintenance of Oral Ingestion have increased in the number of use among slightly disabled persons. However, this increase may be insufficient given the hidden swallowing/feeding difficulty.
吞咽/进食困难是老年人中一个严重的隐性健康问题。尽管自 2006 年以来，日本公共长期护理（LTC）保险已经根据这种困难的程度提供并修订了基于该困难程度的口腔摄入服务，但尚未对其实施情况进行检查。我们评估了政策变化对这些服务的影响。
对日本 LTC 服务使用的全国性数据库进行了分析，涉及三种口腔摄入服务：日托设施中轻度残疾使用者的增强口腔功能、居住设施中维持口腔摄入和从管饲过渡到口腔摄入。从 2015 年到 2020 年，每月使用这些服务的时间是一致的，从 2009 年到 2020 年，根据 LTC 保险认证，用户的比例是根据 6 月的数据提取的。主要政策变化是 2015 年在增强口腔功能中增加了市政拨款，以及在维持口腔摄入中需要多学科合作。还检查了减少开发经皮胃管以过渡到口腔摄入的医疗费用的影响。
2015 年至 2020 年间，增强口腔功能和维持口腔摄入的使用增加，而经皮胃管过渡到口腔摄入的使用减少，导致所有有 LTC 保险认证的老年人的总使用量增加了 27.5 万次，或每 10 万人增加约 5000 次。关于用户残疾状况的比例，2020 年增强口腔功能的主要使用者是轻度残疾和独立的老年人（70%，高于 2009 年的 55%）。关于 2013 年至 2020 年维持口腔摄入的主要使用者，5 级（最严重）的护理需求减少了 11%，而 4 级和 3 级的总数增加了 9%。经皮胃管医疗费用降低后，经皮胃管过渡到口腔摄入的使用量进一步下降，该服务的使用量一直在下降。
由于政策变化，轻度残疾者的增强口腔功能和维持口腔摄入的使用量有所增加。然而，鉴于隐性吞咽/进食困难，这种增加可能还不够。
