居家失能老人之經濟狀態對居家護理使用及照護品質之影響

The Impact of the Economic Status of the Disabled Elderly Dwelling at Home on the Use of Homecare and the Quality of that Care

張淑卿(Shu-Ching Chang) ； 吳肖琪(Shiao-Chi Wu)

《台灣公共衛生雜誌》 31卷5期 (2012/10) Pp. 446-459

https://doi.org/10.6288/TJPH2012-31-05-06

摘要

Objectives: The aims of this study were to determine the effects of the economic status of the disabled elderly on the risk of too infrequent use of homecare and the quality of long-term care. Methods: The subjects of the study were a retrospective cohort of disabled elderly in Taiwan who received homecare services for the first time and were covered by the National Health Insurance from 2002 to 2006. A generalized estimate equation (GEE) used for the logistic regression was utilized to analyze the factors affecting the risk of fewer homecare visits (＜3 times per year). The factors affecting the risks of infection-related hospitalization or pressure sore-related hospitalization were analyzed with a comprehensive Cox regression. Results: A total of 44,856 disabled elderly received homecare for the first time from 2002 to 2006. After the confounding variables were controlled, the comparative risks between different economic status groups were as follows: the risk of fewer homecare visits for the disabled elderly with high economic status was lower than the risk for those with low economic status (Odds ratio [OR]=0.92; 95% confidence interval [CI], 0.86-0.99, p=0.0307). The risk of infection-related hospitalization for the disabled elderly with high economic status was lower than the risk for those with low economic status (Hazard ratio [HR]=0.95, 95% CI:0.92-0.98, p=0.0025). The risk of pressure sore-related hospitalization for the disabled elderly with high economic status was lower than the risk for those with low economic status (HR=0.92, 95% CI:0.85-1.00, p=0.0422). Conclusions: The disabled elderly of low economic status made less use of homecare services and received a lower quality of homecare even though it was provided by National Health Insurance for free. Based on these findings, we suggest that policy makers provide a traffic subsidy to the economically disadvantaged disabled elderly who receive homecare services, improve household sanitation, and promote specialized instruction about homecare during discharge planning and home visits.

關鍵字

失能老人 ； 居家護理 ； 經濟狀態 ； 照護品質 ； 全民健保

並列摘要

Objectives: The aims of this study were to determine the effects of the economic status of the disabled elderly on the risk of too infrequent use of homecare and the quality of long-term care. Methods: The subjects of the study were a retrospective cohort of disabled elderly in Taiwan who received homecare services for the first time and were covered by the National Health Insurance from 2002 to 2006. A generalized estimate equation (GEE) used for the logistic regression was utilized to analyze the factors affecting the risk of fewer homecare visits (＜3 times per year). The factors affecting the risks of infection-related hospitalization or pressure sore-related hospitalization were analyzed with a comprehensive Cox regression. Results: A total of 44,856 disabled elderly received homecare for the first time from 2002 to 2006. After the confounding variables were controlled, the comparative risks between different economic status groups were as follows: the risk of fewer homecare visits for the disabled elderly with high economic status was lower than the risk for those with low economic status (Odds ratio [OR]=0.92; 95% confidence interval [CI], 0.86-0.99, p=0.0307). The risk of infection-related hospitalization for the disabled elderly with high economic status was lower than the risk for those with low economic status (Hazard ratio [HR]=0.95, 95% CI:0.92-0.98, p=0.0025). The risk of pressure sore-related hospitalization for the disabled elderly with high economic status was lower than the risk for those with low economic status (HR=0.92, 95% CI:0.85-1.00, p=0.0422). Conclusions: The disabled elderly of low economic status made less use of homecare services and received a lower quality of homecare even though it was provided by National Health Insurance for free. Based on these findings, we suggest that policy makers provide a traffic subsidy to the economically disadvantaged disabled elderly who receive homecare services, improve household sanitation, and promote specialized instruction about homecare during discharge planning and home visits.

並列關鍵字

Disabled elderly ； Home nursing ； Economic status ； Care quality ； Health Insurance

參考文獻

張朝琴(2008)。貧窮與健康─社經地位與原住民族健康問題探析。嘉義大學通識學報。6，461-86。

王永慈(2005)。台灣的貧窮問題相關研究的檢視。台大社會工作學刊。10，1-54。

曾敏傑(2005)。社會階級與健康不平等的因徑探索。社會政策與社會工作學刊。9，25-76。

葉莉莉、溫敏杰(2003)。台南區域全民健保實施前後居家護理資源使用比較。台灣衛誌。22，287-94。

楊嘉玲、徐亞瑛(2001)。護理之家照護品質指標─以老年住民的觀點探討。護理研究。9，53-64。