Community-based Study on Related Factors of Home Medical Care Utilization Among Disabled People

• Main Authors: CHOU,YAO-CHUN, 周姚均
• Other Authors: HUNG, CHI-FENG
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/8nv825

碩士 === 輔仁大學 === 跨專業長期照護碩士學位學程在職專班 === 107 === Aims: Under the situation of rapid aging and comorbidity, aging in place might be the best choice for the disabled persons. In order to make the elderly's wish come true, we should use the resource of long-term care to take care of them. Besides, utilizing home medical care services is also important for the persons who can't get access to medical treatment easily. Therefore, the aim of this study was to discuss the disabled community dwellers’ social demography, physical conditions, the utilization of long¬term caring service items, and the use of home medical care. In this study, cases that have been provided with the services of long-term care from a -certain area in Taipei City were selected as the study subjects. By studying the cases, we can learn the factors that influence the utilization of home medical care resources, evaluate the situation of the use of resources, both of which could help to build an integrated care system and provided as a reference source for the government’s policy. Method: The research was a retrospective study. The persons who were subsidized through a long-term care management at the certain hospital from January 1 to December 31 in 2017 were selected to be the study subjects. A total of 2370 people were included. The study wants to realize the characteristics and differences between disabled community dwellers' social demography, physical conditions, the utilization of long-term caring service items and the use of Home Medical Care by using SPSS 22.0, the statistical software, including descriptive statistics, chi-square test, independent sample t test, analysis of variance(ANOVA), and logistic regression. Results: Disabled community dwellers' social demography which is concerns age, welfare identity, living alone or not, climbing stairs in the residence or not and the degree of urbanization in the place of residence is significantly associated with the utilization of home medical care services. Disabled community dwellers' health condition which includes charlson co-morbidity index by quan (CCI-Q), function in daily life, on the LTC-CMS scale is significantly associated with the utilization of home medical care services. The long-term caring service items including day care services and residential rehabilitation are significantly associated with the utilization of home medical care services. After correcting the relevant factors, the data shows that odds ratio of the utilization of home medical care services will increase 1.020 times when disabled community dwellers increase their age every year. The data also shows that odds ratio of the utilization of home medical care will increase 1.334 times when CCI-Q increases one score. In addition, odds ratio of the utilization of home medical care services will increase 3.065 times when disabled persons increase each of the long-term care services. Further analysis reveals that the utilization of home medical care services has significantly of higher low-income households (OR:2.367, 95% CI:1.437-4.143), of people living on the second floor or more without elevators (OR:1.747, 95% CI: 1.250-2.442) , of people complete dependence in daily life (OR:5.374, 95% CI:5.444-1.997) , of people are verified as the 4th (OR:0.319, 95% CI:0.114-0.887) , as the 5th (OR:0.322, 95% CI:0.110-0.943) ,and as 7 th on the LTC-CMS scale (OR:0.222, 95% CI:0.064-0.775) ,of using care services of day care (OR:0.080, 95% CI:0.016-0.407) ,of residential rehabilitation (OR:0.080, 95% CI:0.016-0.407). Conclusion:To disabled community dwellers, the demand for home health care would increase as they become older as well as the comorbidity index and the long-term care requirement grow. Therefore, we should take deeper assessment on the disabled community dwellers’ need of home medical care if they (1) are low-income households, (2) live on the second floor or more without elevators, (3) need complete dependence in daily life, (4) are verified as the 4th, 5th, and 7th on the LTC-CMS scale, (5)are the users of in-home rehabilitation service. In this way, disabled community dwellers are able to obtain the resource of long-term care and medical services, realizing the dream of aging in place.