Municipal variation in health and social service use in the last 2 years of life among old people
ABSTRACT To describe and analyse municipal differences in health and social service use among old people in the last 2 years of life.
The data were derived from national registers. All those who died in 2002 or 2003 at the age of ≥ 70 years were included except those who lived in very small municipalities. The services included were different types of hospitals, long-term care, and home care. The variation in service use was described by coefficients of variation (CV). To analyse local differences, three-level (individual, municipal, and regional) binary logistic and Poisson regression analyses were performed.
A total of 67,027 decedents from 315 municipalities in 20 hospital districts were included. There was considerable variation in service use between residents of different municipalities, especially in the types of hospital used. Of the individual-level variables age and use of other services were associated (p < 0.05) with use of all services. Of the municipal-level variables, indicators describing the service pattern in the municipality were associated with use of all services and average age of decedents with most of the services. The presence of a university hospital in the hospital district increased the probability of using university and general hospitals, but among the users increased days in university hospital and decreased days in general hospital.
Considerable differences between municipalities exist, but these cannot be exhaustively explained. Behind the differences are probably factors which are difficult to describe and quantify, such as historical developments and political realities.
SourceAvailable from: Mika Immonen[Show abstract] [Hide abstract]
ABSTRACT: Read full article at: http://www.emeraldinsight.com/doi/pdfplus/10.1108/IJPSM-03-2014-0035 Purpose This article focuses on the availability and demanded locations of health care services in a rural context. We analyse subjective experiences because mobility and other individual factors influence the availability of public services. Design/methodology/approach Results from a mail survey in southeastern Finland are presented. Data collection was conducted using a random sample of 3,000 people from age 60 to 90 years. A total of 1,121 valid responses were received. Findings The acceptable distance to service sites depends on learned behaviour where differences exist between suburban and rural residents. We found that service networks can be sparser in rural areas if the service sites are located in the daily activity space of the residents and travel burdens caused by distance and time are adequately solved. However, continuous downscaling of the provision may lead to the loss of health benefits which is harmful for individuals and expensive for society. Research limitations/implications Further research should assess a broader variety of residential areas from the perspective of service availability. The results presented do not enable a direct comparison of the service availability between cities and sparsely populated rural areas. Originality/value The article contributes to the debate on access barriers to public service in rural regions. The question of availability of public services is topical because increasing overall demand requires urgent productivity improvements in public services. Currently this is solved by centralisation to search economies of scale.International Journal of Public Sector Management 01/2015; 28(1):-. · 0.32 Impact Factor
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ABSTRACT: Aims: To analyse whether transitions between care settings differ between municipalities in the last 2 years of life among older people in Finland. Methods: Data were derived from Finnish national registers, and include all those who died in 2002 and 2003 at the age of 70 or older except those living in very small municipalities (n=67,027). Data include admissions and discharges from health and social care facilities (university hospitals, general hospitals, health centres, residential care facilities) and time spent outside care facilities for 730 days prior to death. Three-level negative binomial regression analyses were performed to study the effect of municipal factors on (1) the total number of all care transitions, (2) the number of transitions between home and different care facilities, and (3) transitions between different care facilities. Results: The municipality of residence had only a minor effect on the total number of care transitions, but greater variation between municipalities was found when different types of care transition were examined separately. Largest differences were found in care transitions involving specialised care. Age structure, urbanity, and economic situation of the municipality had an impact on several different care transitions. Conclusion: The total number of care transitions in 2 final years of life was approximately similar irrespective of the municipality of residence, but the findings imply differences in transitioning specialised care. Potentially, this may suggest inequality between the municipalities, but more detailed studies are needed to confirm the factors underlying these differences.Scandinavian Journal of Public Health 04/2013; 41(6). DOI:10.1177/1403494813484396 · 3.13 Impact Factor
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ABSTRACT: Aims and objectivesTo identify descriptions of older (75+) home care clients and practical nurses regarding the current structure of home care available for older clients and the elements promoting the ability of clients to continue living at home. Background The ageing population is a major global challenge in social and health care. In many countries, the focus of care for older clients has shifted from institutional care towards a model of home care. Increasing attention has been paid to maximising the resources of older clients and aiming to support their living at home for as long as possible. DesignA descriptive qualitative study Methods Data were collected from individual interviews by using videotaped home care visits as a tool for stimulated recall interviews. Two groups of participants were interviewed: 14 practical nurses and 23 older clients. Data were analysed by using the inductive content analysis. ResultsBoth participant groups, practical nurses and older home care clients, described home care as organisationally driven, but highlighted the importance of individual encounters. In addition, both groups noted that clients' living at home can be supported by offering individually designed care. Individually designed care refers to showing respect to clients' opinions and promoting their individual resources. Conclusion In order to be able to promote older home clients' living at home, the provided home care needs to be individually designed and must take into account clients' resources and their perspectives of meaningful and inspirational activities. Relevance to clinical practiceThe information produced by this study can be used to promote older clients' living at home for as long as possible. Therefore, practical nurses are required the ability to recognise older clients' individual resources and design individual care plans accordingly.Journal of Clinical Nursing 02/2014; 23(21-22). DOI:10.1111/jocn.12569 · 1.23 Impact Factor