Service Demand for and Awareness of a Primary Healthcare Pilot Project for People With Disabilities.

BACKGROUND: This study investigated the demand for and awareness of a primary healthcare pilot project for people with disabilities; it also sought to identify relevant determinants for demand and awareness using Andersen's behavioral model of health service use. METHODS: This study is a secondary analysis of data from the population-based survey conducted in Gyeonggi Regional Health & Medical Center for People with Disabilities. The data was designed with quota random sampling based on the population with disabilities in each district (city [si] and county [gun]) across the Gyeonggi province (do) to evaluate the health and healthcare accessibility of the disabled people living in the Gyeonggi province. The data was collected through the mobile-based survey of 1,140 people with disabilities living in Gyeonggi-do between March 2021 and June 2021. RESULTS: Awareness of the service (12.1%) was remarkably low, while the demand (80.5%) was high. The gap between respondents who needed the service but were unaware of it differed according to age, education, activities of daily living, health information sources, chronic disease, depression, subjective health status, and unmet healthcare needs. Chronic disease (odds ratio [OR], 1.86; P = 0.001) and an unmet need for medical care (OR, 2.30; P = 0.002) had significant influences on demand for the service. Furthermore, living alone (OR, 0.42; P = 0.023), medical aid program beneficiary status (OR, 2.10; P = 0.020), access to health information from health service centers (OR, 4.00; P = 0.002), chronic disease (OR, 1.68; P = 0.043), severity of disability (OR, 1.78; P = 0.025), and subjective health status (OR, 4.51; P < 0.001) significantly affected awareness of the program. CONCLUSION: Chronic disease and an unmet need for medical care were key determinants of service demand, while the severity of disability was not. Thus, there is a need to review the initiative that defines service beneficiaries as people with severe disabilities. Policy makers should consider advertising programs to improve service awareness among people with disabilities.

Walking speed and short physical performance battery are associated with conversion to long-term care need: A study in outpatients of a locomotive syndrome-frailty clinic.

AIM: As the number of frail and disabled older people increases in Japan, systems are needed to detect efficiently the populations at high risk in need of care and to allow early intervention. We investigated cut-off values for those physical functioning assessments adopted by AWGS 2019 associated with new or worsening long-term care insurance (LTCI) certification. METHODS: We recruited 497 outpatients from our locomotive syndrome-frailty clinic. After excluding patients who had undergone orthopedic surgery right after assessment or ≤65 years old, 233 patients (mean age, 78 ± 6 years) were included. Logistic regression analysis was performed using new certification for LTCI services need or deterioration of care status in 1 year as the dependent variable and physical function and other assessments as independent variables. Next, we constructed receiver operating characteristic curves and calculated areas under the curve and optimal cut-off values. RESULTS: During 1-year follow-up, 37 patients (16%) obtained new certification for LTCI services need or deterioration of status. After adjusting, usual walking speed and Short Physical Performance Battery score were significantly associated with outcomes. With receiver operating characteristic curves, usual walking speed as the test variable showed an area under the curve of 0.740 with a cut-off of 0.92 m/s, whereas the Short Physical Performance Battery score showed an area under the curve of 0.737 with a cut-off score of 9. CONCLUSIONS: Slower walking speed and lower Short Physical Performance Battery score may predict new or worsening LTCI for older people. Geriatr Gerontol Int 2021; 21: 919-925.

Perceived unmet needs for community-based long-term care services among urban older adults: A cross sectional study.

The purpose of this study was to explore the perceived unmet needs for community-based long-term care services among older urban adults in China. We analyzed the cross-sectional data of 5,201 urban community respondents ≥65 years of age from the seventh wave of the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). The chi-squared automatic interaction detection technique was used to examine the variables associated with older adults' unmet needs for four common types of community-based services: personal care, grocery shopping, home visits, and psychological consulting. We found that the majority of the older adults perceived that they needed the four services, but only 9%-27.4% of the respondents reported that their perceived needs were met. There was a high prevalence of unmet community-based service needs (51.3%-55.5%) among urban older adults in China. Factors associated with unmet needs included depression status, ADL (activities of daily living) limitations, self-rated health, number of surviving children, educational attainment, and marital status. The results suggest that policy makers should develop services targeting specific segments of the older population, increasing the adequacy of services provided.

Is intensive case management screening sheet score associated with service intensity?

AIMS: Since April 2020, the new Japanese mental health system has used the Intensive Case Management Screening Sheet (ICMSS) to identify patients' needs for case management services. This study aimed to examine the association between ICMSS score and service intensity and compare the magnitude of association between ICMSS score and service intensity with other scales. METHODS: We recruited patients who received case management services from a staff member in a psychiatric outpatient service, psychiatric day-care program, or outreach team based at one psychiatric hospital. Case management service needs and functioning were assessed using ICMSS, Global Assessment Functioning (GAF), and Personal and Social Performance (PSP). The case manager also documented all services received by the participant for 2 months. The association between each scale and service duration was examined. Furthermore, the magnitude of the association between each scale and service intensity was compared. RESULTS: Overall, 138 participants were included in the analysis. The most common diagnosis was schizophrenia. Mean total service duration was weakly but significantly correlated with ICMSS (Spearman's ρ = 0.320), GAF (ρ = -0.198), and PSP (ρ = -0.275) scores. Poisson's regression models and postestimation testing showed that the coefficient for ICMSS score (B = 0.144; 95% CI = 0.141, 0.148) was significantly larger than the coefficients for GAF (B = -0.017, 95% CI = -0.017, -0.016, χ2  = 15.70, P < 0.001) and PSP (B=-0.016, 95% CI = -0.017, -0.016, χ2  = 14.64, P < 0.001) scores. CONCLUSION: ICMSS may provide preliminary information on case management service needs, but the level of service should be based on the individual needs of each patient and shared decision-making between the patient and case manager.

Determinants of Patterns of Need for Home and Community-Based Care Services Among Community-Dwelling Older People in Urban China: The Role of Living Arrangement and Filial Piety.

This study aims to identify older people's home- and community-based care (HCBC) service need patterns and explore the role of living arrangement and filial piety in affecting such patterns. A total of 556 older people were selected in Beijing, China. Latent class analysis and multinomial logistic regression were adopted to identify the service need patterns and the influencing factors. A three-class model of service need patterns was explored (high-needs group, moderate-needs group, and low-needs group). Living arrangement was related to HCBC service need patterns. Compared with the high-needs group, those living with at least two family members were more likely to express low needs or moderate needs. Living arrangement was a moderator for the effect of filial piety on HCBC needs. Greater recognition of the effects of living arrangement and filial piety should enrich the Andersen model and provide a robust stimulus for long-term care policy development and for service delivery and social work.

Young Adult Mental Health: a Prospective Examination of Service Utilization, Perceived Unmet Service Needs, Attitudes, and Barriers to Service Use.

Most young adults with mental health symptoms do not receive treatment or access services. It remains important to identify barriers to service utilization to improve access to care. The current study was a prospective analysis examining predictors of (a) mental health service utilization and (b) perceived unmet need for mental health services. Barriers to service utilization were examined by prior depression severity status and college student status. Participants included a subsample of young adults ages 18-23 at time of recruitment who were participating in a longitudinal monthly study who completed both baseline and a 15-month follow-up assessment (N = 622, 80% of larger study). At month 15, 23% of young adults reported receiving mental health services in the past 12 months; 26% of young adults reported a perceived unmet need for mental health services at some point in the past 12 months. There were differences in demographic and mental health predictors of service utilization and perceived unmet need for services. Women, sexual minorities, those with moderate depression, those with more impairment from depression, and perceived past year poor mental health were associated with greater likelihood of receiving services. Similar demographic characteristics were associated with greater likelihood of perceiving unmet need for services. Barriers to service utilization differed by severity of depression symptoms and student status. Young adults have distinct reasons for not accessing mental health services; addressing these to improve accessibility to care remains critical.

Use of Disease-modifying Antirheumatic Drugs for Inflammatory Arthritis in US Veterans: Effect of Specialty Care and Geographic Distance.

OBJECTIVE: To evaluate the effect of access to and distance from rheumatology care on the use of disease-modifying antirheumatic drugs (DMARD) in US veterans with inflammatory arthritis (IA). METHODS: Provider encounters and DMARD dispensations for IA (rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis) were evaluated in national Veterans Affairs (VA) datasets between January 1, 2015, and December 31, 2015. RESULTS: Among 12,589 veterans with IA, 23.5% saw a rheumatology provider. In the general IA population, 25.3% and 13.6% of veterans were exposed to a synthetic DMARD (sDMARD) and biologic DMARD (bDMARD), respectively. DMARD exposure was 2.6- to 3.4-fold higher in the subpopulation using rheumatology providers, compared to the general IA population. The distance between veterans' homes and the closest VA rheumatology site was < 40 miles (Near) for 55.9%, 40-99 miles (Intermediate) for 31.7%, and ≥ 100 miles (Far) for 12.4%. Veterans in the Intermediate and Far groups were less likely to see a rheumatology provider than veterans in the Near group (RR = 0.72 and RR = 0.49, respectively). Exposure to bDMARD was 34% less frequent in the Far group than the Near group. In the subpopulation who used rheumatology care, the bDMARD exposure discrepancy did not persist between distance groups. CONCLUSION: Use of rheumatology care and DMARD was low for veterans with IA. DMARD exposure was strongly associated with rheumatology care use. Veterans in the general IA population living far from rheumatology sites accessed rheumatology care and bDMARD less frequently than veterans living close to rheumatology sites.

Quality of life and nursing service need in eldly low vision patients / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the quality of life of elderly patients with low vision and its nursing service demand,in order to improve the quality of life of elderly low vision group and provide theory basis.METHODS:A cross-sectional study method,in a tertiary hospital in Fuzhou city elderly patients with low vision 200 cases were as the research object,USES the Chinese version of quality of life scale (CLVQOL),low vision care service demand questionnaire investigation were taken.RESULTS:In elderly patients with low vision life quality score was 54.92±12.11,the nursing service demand score 30.34± 8.93,medium and high demand was of 88％.Quality of life was negatively correlated with nursing service demand value (r=-0.266,P＜0.01).CONCLUSION:The quality of life of elderly patients with low vision was low,nursing service demand is high,especially on visual function recovery training of nursing service requirements.Aging brings important social problems in China,attaches great importance to the elderly care service demand,discussion with precise visual nursing care intervention in low vision group,it is necessary to improve the quality of life.

Priority service needs and receipt across the lifespan for individuals with autism spectrum disorder.

Individuals with Autism Spectrum Disorder (ASD) have a range of health, community, and social support needs across the lifespan that create age-specific challenges in navigating service sectors. In this study, we set out to identify the priority needs of individuals with ASD across the lifespan, and the factors that predict receiving priority services. Participants included 3,317 individuals with ASD from a Canada-wide online caregiver survey, stratified into five age groups (preschool, elementary school age, adolescence, emerging adulthood, adulthood). Priority receipt was calculated as a ratio of current services that corresponded to individualized priority need. Age-stratified Poisson regression analyses were used to identify the sociodemographic, clinical and systemic predictors of priority receipt. Results indicate that the distribution of priority need varied by age, except for social skills programming, which was a high across all groups. The number of high and moderate priority needs diversified with age. Overall, 30% of individuals had none of their priority needs met and priority receipt decreased with age. Systemic factors were most consistently related to priority receipt across the lifespan. Understanding patterns and correlates of priority needs and use that currently exist in different age groups can inform policies to improve service access. Autism Res 2017, 10: 1436-1447. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

Environmental Predictors of Unmet Home-and Community-Based Service Needs of Older Adults.

Home- and community-based services (HCBS) for many older adults are an essential component of aging-in-place. Andersen developed the contemporary model used to predict service use. Researchers have modified the model to examine need. Studies that attempt to predict unmet needs have explained only 10% to 15% of the variance. This study is based on the supposition that lack of accounting for environmental factors has resulted in such small explanatory power. Through the use of 2008 Southeastern Pennsylvania Household Health Survey data, this exploratory study modeled predictors of unmet HCBS needs. Findings reveal that lack of access to healthy foods and poor housing quality have a significant relationship to unmet HCBS needs. This model predicted 54% of the variance. Results reveal environmental questions to ask, a way to identify older adults with unmet HCBS needs and environmental barriers that if addressed may reduce older adults' eventual need for health services and HCBS.

Management status quo of migrant workers with chronic hepatitis B and countermeasures research / 重庆医学

Objective To understand the management status quo of migrant workers with chronic hepatitis B (CHB) to ex‐plore the management countermeasures and improve the survival quality for tamping the foundation of the healthy project .Methods Totally 300 migrant workers with CHB were performed the living quality evaluation and investigation on the service needs ,com‐pliance ,economic condition ,categories and proportion of reimbursement by adopting the supplementary revision of SF‐36 living quality scale and general information questionnaire ;the influencing factors of their living quality were performed the univariate anal‐ysis and multivariate stepwise regression analysis .Results The statistical analysis found that whether convenient for outside visit‐ing hospital ,categories and proportion of reimbursement ,whether normalized antiviral therapy ,whether conducting examination and follow up at regular intervals and liver disease specific symptoms were the influencing factors of living quality in the migrant work‐ers with CHB(P<0 .05);the living quality in the patients with outside convenient visiting hospital ,high reimbursement proportion , normalized antiviral therapy and examination and follow up at regular intervals was significantly higher than that in the patients with inconvenient outside visiting hospital ,low reimbursement proportion ,non‐normalized anti‐viral therapy and examination and follow up without regular intervals(P<0 .05);the liver disease specific symptom score showed the positive correlation trend with the living quality score (B=7 .657 ,SD=2 .650 ,t=2 .889 ,P=0 .004) .Conclusion It is necessary to improve the patient′s medical needs ,reimbursement type and proportion ,increase the compliance of patient′s normalized examination and follow‐up at regular in‐tervals and standard antiviral treatment ,thus to realize the standardized examination and treatment in CHB patients ,prevent or de‐lay the disease progression ,avoid liver cirrhosis and decompensated hepatopathy ,reduce the occurrence of HCC ,improve the quality of life and prolong the survival period .

Self-injurious, aggressive and destructive behaviour in children with severe intellectual disability: Prevalence, service need and service receipt in the UK.

Children with severe intellectual disabilities are at increased risk of presenting with self-injurious, aggressive and destructive behaviour. Severity of these behaviours is an important predictor of psychological and behavioural service use by people with intellectual disabilities. However, studies suggest that the needs of children with intellectual disabilities and their families are not being met. The aims of the present study were to: (1) describe the self-injurious, aggressive and destructive behaviours and subsequent support needs of children with severe intellectual disabilities attending special schools in one major city within the UK, (2) compare teacher and primary carer ratings of behaviour and service need and (3) explore the extent to which the needs of children with intellectual disabilities are being met in terms of contact with relevant specialist services. Questionnaires were completed by teachers and primary family carers of children with a severe intellectual disability. Results indicated that at least 5.3% and 4.1% of children showed at least one behaviour at a clinically significant frequency and management difficulty respectively. Primary carers identified more children with significant behaviour difficulties and support needs than teachers. The odds for children presenting with high levels of the behaviours of interest for having a service need for behavioural intervention were at least 13 times those for children not showing the behaviours, yet only doubled for contact with a specialist relevant health-care professional. These results quantify the magnitude of the substantial gap between level of need and relevant support received.

Healthcare professional requirements for the care of adult diabetes patients managed with insulin pumps in Australia.

BACKGROUND: Healthcare professional (HCP) time supporting insulin pump therapy (IPT) has not been documented, yet it is important in planning and allocating resources for effective care. AIM: This study aims to determine HCP time spent in IPT patient care to inform resource planning for optimal IPT delivery. METHODS: Twenty-four Australian adult IPT-experienced institutions (14 government funded, seven private, three both) collected data between April 2012 and January 2013 prospectively, including: patient demographics, HCP classification, purpose of HCP-patient interaction, interaction mode and HCP time with the patient. A subset of patients was tracked from pre-pump education until stable on IPT. RESULTS: Data on 2577 HCP-adult patient interactions (62% face-to-face, 29% remote, 9% administrative) were collected over 12.2 ± 6.4 weeks for 895 patients; age 35.4 ± 14.2 years; 67% female; 99% type 1 diabetes, representing 25% of all IPT patients of the institutions. Time (hours) spent on IPT interactions per centre per week were: nurses 5.4 ± 2.8, dietitians 0.4 ± 0.2 and doctors 1.0 ± 0.5. IPT starts accounted for 48% of IPT interaction time. The percentage of available diabetes clinic time spent on outpatient IPT interactions was 20.4%, 4.6% and 2.7% for nurses, dietitians and doctors respectively. Fifteen patients tracked from pre-pump to stabilisation over 11.8 ± 4.5 weeks, required a median (range) of 9.2 (3.0-20.9), 2.4 (0.5-6.0) and 1.8 (0.5-5.4) hours per patient from nurses, dietitians and doctors respectively. CONCLUSIONS: IPT patient care represents a substantial investment in HCP time, particularly for nurses. Funding models for IPT care need urgent review to ensure this now mainstream therapy integrates well into healthcare resources.

Community care for the Elderly: Needs and Service Use Study (CENSUS): Who receives home care packages and what are the outcomes?

AIM: Investigate factors associated with waiting times for home care packages and outcomes for care recipients and carers. METHOD: Analyses of data collected every four months for 12 months from 55 community-dwelling older adults eligible for government-subsidised packaged care and their carers. RESULTS: Thirty of fifty-five participants were offered a package; they waited from one to 237 days. Baseline quality of life was higher for those offered a package than those not. Baseline care needs and unmet needs, neuropsychiatric symptoms, and cognitive decline did not predict offers. Package receipt compared to non-package receipt was associated with decreased carer burden over time but did not affect levels of unmet care needs, care needs or quality of life. CONCLUSIONS: Being offered a home care package was not based on waiting time or unmet care needs. Reforms should include a transparent system of wait listing and prioritisation.

Predictors of Nursing Service Need for Nursing Homes Residents

PURPOSE: The purposes of this study were to explore the functional status of elderly residents and to analyze time use, and finally identify factors to predict nursing care needs in relation to functional status and health related variables. METHODS: In this study a descriptive-correlational design was used. Functional status of participants was obtained through interviews, and nursing care time was examined using a 1 min time-motion study with a standardized instrument developed by Korea Long-Term Care Planning Committee (2005). RESULTS: The mean total functional score was 65 (range 28-125) and mean total nursing care time was 144.15 min per day. There were significant positive relationships between total nursing care time, marital status, back pain, dementia, and vision impairment. Multiple regression analyses showed that a liner combination of number of illnesses, types of primary disease, ADL, IADL, cognitive function, nursing demand, and rehabilitation demand explained 42.8% of variance of total nursing time. ADL (beta=-.533) was the most significant predictor of nursing service need. CONCLUSION: Identifying factors that result in variations of service need has implications for adequate nursing service, estimation of optimum nurse to patient ratio, quality of care and patient safety.

The Study on the Medical and Nursing Service Needs of the Terminal Cancer Patients and Their Caregivers / 간호학회지

In this study, we attempted to investigate the needs and problems of the terminal cancer patients and their family caregivers to provide them with nursing information to improve their quality of life and prepare for a peaceful death. Data was collected from August 1, 1995 to July 31, 1996 at the internal medicine unit of S hospital in Seoul area with the two groups of participants who were family members of terminal cancer patients seventy four of them were in-patients and 34 were out-patients who were discharged from the same hospital for home care. The research tool used in this study has been developed by selecting the questionnaires from various references, modifying them for our purpose and refining then based on the results of preliminary study. While general background information about the patients was obtained by reviewing their medical records, all other information was collected by interviewing the primary family caregivers of the patients using the questionnaire. The data collected were analyzed with the SPSS PC+ program. The results of this study are summarized as follows; 1) Most frequently complained symptoms of the terminal cancer patients were in the order of pain(87%), weakness(86.1%), anorexia(83.3%) and fatigue(80.6%). 2) Main therapies for the terminal cancer patients were pain control(58.3%), hyperalimentation(47.2%) and antibiotics(21.3%). 3) Special medical devices that terminal cancer patients used most were oxygen device(11.1%), and feeding tube(5.6%). Other devices were used by less than 5% of the patents. 4) The mobility of 70.4% of the patients was worse than ECOG 3 level, they had to stay in bed more than 50% of a day. 5) Patients wanted their medical staffs to help relieve pain(45.4%), various physical symptoms(29.6%), and problems associated with their emotion(11.1%). 6) 16.7% of the family caregivers hoped for full recovery of the patients, refusing to admit the status of the patients. also, 37% wished for the extension of the patient's life at least for 6 months. 7) Only 38.9% of the family members was preparing for the patient's funeral. 8) 45.4% of family caregivers prefer hospital as the place for the patient's death, 39.8% their own home, and 14.8% undetermined. 9) caregivers of the patients were mostly close family members, i.e., spouse(62%), and sons and daughters or daughter-in-laws(21.3%). 10) 43.5% of the family caregivers were aware of hospice care. 46.8% of them learned about the hospice care from the mass media, 27.7% from health professionals, and the rest from books and other sources. 11) Caregivers were asked about the most difficult problems they encounter in home care, 41 of them pointed out the lack of health professionals they can contact, counsel and get help from in case of emergency, 17 identified the difficulty of finding appropriate transportation to hospital, and 13 stated the difficulty of admission in hospital as needed. 12) 93.6% of family caregivers demanded 24-hour hot line, 80% the visiting nurses and doctors, and 69.4% the volunteer's help. The above results indicate that terminal patients and their family caregivers demand help from qualified health professionals whenever necessary. Hospice care system led by well-trained medical and nursing staffs is one of the viable answers for such demands.