Ohashi Kazuki, Sato Miho, Fujiwara Kensuke, Tanikawa Takumi, Morii Yasuhiro, Ogasawara Katsuhiko
Faculty of Health Sciences Hokkaido University Sapporo Japan.
Graduate School of Commerce Otaru University of Commerce Otaru Japan.
Health Sci Rep. 2024 Sep 16;7(9):e70078. doi: 10.1002/hsr2.70078. eCollection 2024 Sep.
Japan is one of the oldest societies worldwide and manages a system of care for older adults in the community. In the 2000s, a community-based integrated care system was introduced to enable older adults to live in their neighborhoods. Home visiting nursing (HVN) is a crucial component of this system; however, the current and future shortage of home visiting nurses is a concern. Thus, HVN services may not be available in some areas; however, no indicators of the accessibility of HVN services have been developed. Developing accessibility indicators will serve as a standard for considering the allocation of health care resources and supporting future nursing policies that improve regional disparities.
We estimated the population-weighted spatial accessibility index (PWSAI) of HVN services in Hokkaido, using the two-step floating catchment area method (2SFCA). The 2SFCA comprised population, location of HVN agencies, number of home visiting nurses, and travel time. A multivariate regression model was run for the number of HVN users in each municipality as the objective variable to test the validity of the PWSAI; the number of home care support clinics, home care support hospitals, HVN agencies, home visiting nurses, home visiting nurses (24/7), total beds in health care facilities for older adults, and nursing homes for older adults were included as other explanatory variables.
The PWSAI was median 9.0 [interquartile range: 6.2-11.8]. The distribution of the PWSAI was mapped to visualize the existence of regional differences. As a result of the conditional autoregressive model, PWSAI and home visiting nurses (24/7) were significant, Exp() and 95% credible interval were 1.043 [1.015-1.076] and 1.021 [1.006-1.036], respectively.
The PWSAI was positively correlated with the number of HVN users in each municipality and can serve as an indicator for assessing the accessibility of HVN.
日本是全球老龄化程度最高的社会之一，并且管理着一套针对社区老年人的护理体系。在21世纪初，引入了基于社区的综合护理体系，以使老年人能够在自己的社区生活。上门护理（HVN）是该体系的关键组成部分；然而，目前和未来上门护士短缺令人担忧。因此，某些地区可能无法获得HVN服务；但是，尚未制定HVN服务可及性的指标。制定可及性指标将作为考虑医疗资源分配以及支持改善地区差异的未来护理政策的标准。
我们使用两步浮动集水区法（2SFCA）估算了北海道HVN服务的人口加权空间可及性指数（PWSAI）。2SFCA包括人口、HVN机构的位置、上门护士的数量和出行时间。以每个市町村的HVN用户数量作为目标变量运行多元回归模型，以检验PWSAI的有效性；将家庭护理支持诊所、家庭护理支持医院、HVN机构、上门护士、全天候上门护士、老年人保健设施的总床位数以及老年人养老院的数量作为其他解释变量。
PWSAI的中位数为9.0[四分位间距：6.2 - 11.8]。绘制了PWSAI的分布图以直观显示地区差异的存在。条件自回归模型的结果显示，PWSAI和全天候上门护士具有显著性，Exp()和95%可信区间分别为1.043[1.015 - 1.076]和1.021[1.006 - 1.036]。
PWSAI与每个市町村的HVN用户数量呈正相关，可作为评估HVN可及性的指标。
