Medical Services Utilization Patterns by Seniors

Bridging the Knowledge Gap: From Evidence to Policy and Practice that Fosters Seniors' Independence

Cette synthèse vise à mettre en relief certaines conclusions des autres articles de ce numéro et à démontrer de quelle façon on peut les utiliser dans la conception de politiques et de soins de santé qui mettront de l'avant une réforme assurant l'autonomie des aîné(e)s. L'article examine d'abord la réforme de santé et s'y appuie pour commenter les principales conclusions des études du présent numéro. Le débat porte ensuite sur l'importance de la preuve présentée pour l'élaboration des politiques, la planification et les pratiques dans le contexte actuel. Chaque section se termine par la présentation de l'écart pour lequel il faudra faire un examen plus approfondi de la documentation ou sur lequel il faudra pousser la recherche.

Health Service Utilization among Older Adults in British Columbia: Making Sense of Geography

The utilization of health services by older adults has received increased attention over the past decade, but little is known about how service utilization varies between rural and urban areas. In an era of restructuring and downsizing within the Canadian health care system, there are concerns that rural older adults may be increasingly disadvantaged when it comes to accessing health care. This article examines the utilization of a range of health services by older adults living in urban and rural communities in British Columbia. A major strength of this article is its concurrent focus on a continuum of geographic communities and a broad range of services needed and used by older populations. The research utilizes provincial administrative health data from 48,407 older residents of British Columbia who used services in 1998–1999. Multivariate analyses of co-variance reveal some unique service utilization patterns by geographical area and population.

Anticipating Change: How Many Acute Care Hospital Beds Will Manitoba Regions Need in 2020?

Being able to anticipate future needs for health services presents a challenge for health planners. Using existing population projections, two models are presented to estimate the demand for hospital beds in regions of Manitoba in 2020. The first, a current-use projection model, simply projects the average use for a recent three-year period into the future. The second, a 10-year trend analysis, uses Poisson regression to project future demand. The current-use projection suggests a substantial increase in the demand for hospital beds, while the trend analysis projects a decline. The last projections are consistent with ongoing increases in rates of day surgeries and declines in lengths of stay. The current-use projections need to be considered in the context of relatively low occupancy rates in rural hospitals and previous research on appropriateness of stays in acute care hospitals. If measures are taken to ensure more appropriate use of acute care hospital beds in the future, then the current-use projections of bed shortages are not a cause for concern.

Does Geography Matter? The Health Service Use and Unmet Health Care Needs of Older Canadians

Le coût croissant de soins de santé et le changement des profils démographiques ont entraîné le déplacement et la redistribution du financement et des services entre les zones rurales et urbaines. La plupart des analyses économétriques de l’utilisation de services de santé au Canada incluent des contrôles larges selon la province et l’état rural/urbain; mais relativement peu du travail économétrique a porté sur la variation géographique dans l’utilisation de services de santé. À l’aide de l’Enquête sur la santé dans les collectivités canadiennes (ESCC 2.1), nous avons examiné les déterminants de diverses mesures d’utilisation des services de santé par les Canadiens âgés de 55 ou plus d’une gamme de zones urbaines et rurales de résidence. Notre analyse de régression a montré que les anciens résidents dans les zones rurales font moins visites chez un omnipraticien, chez un spécialiste et chez un dentiste par rapport aux résidents urbains. Tout étant égal, il n’existe aucune différence significative parmi nuits passées à l’hôpital ou dans les besoins de soins de santé non satisfaits. Cependant, apres contrôle pour les caractéristiques démographiques, le statut socioéconomique, l’assurance santé privée et l’état de santé, ces différences sont importantes.

A methodology for estimating hospital bed need in Manitoba in 2020

A team of health researchers of the Manitoba Centre for Health Policy at the University of Manitoba was asked to forecast the number of acute care hospital beds that will be required to meet the needs of residents of the province of Manitoba by the year 2020. Methodological considerations for this request included identification of factors expected to affect bed use in the future, and how to account for these factors. The objective of this paper is to describe these methodological considerations, how decisions were made, and steps taken in our approach to this problem. The actual projections and their implications are the subject of another contribution in this issue of the journal (Finlayson, Stewart, Tate, MacWilliam & Roos, 2005).

Use of physician services by older adults: 1991/1992 to 2000/2001

Canadians have expressed concern that access to family physicians (FP) has declined. Anonymized physician services data for 1991/1992 to 2000/2001 were used to evaluate changes in supply and age-specific rates of use of FPs and specialists in Winnipeg, Manitoba. Physician-to-population ratios declined 7.5 per cent, FP-to-population ratios declined 4.8 per cent, and specialist-to-population ratios declined 10.0 per cent. Among the general population, FP visit rates declined 3 per cent. Among older adults, physician visit rates increased 2.3 per cent, FP visit rates increased 10.9 per cent, and specialist visit rates declined 15.7 per cent. By comparison, we document declines in FP use by those younger than 5 years (25.5%) and those 6 to 19 years of age (18.6%). Increases in FP and declines in specialist use occurred primarily among those aged 65 to 84 years. By 2000/2001 older adults accounted for 25 per cent of all FP encounters. Gains in FP use among older adults was less attributable to the presence of more seniors and more related to the fact that a higher proportion of them are visiting a FP each year and, potentially, substituting primary for secondary care.

Informal caregivers' experiences of formal support in a changing context

As the location of long-term care of elderly people moves to homes and communities, and responsibility for care shifts to families, understanding the experience of people in this situation is necessary to ensure that support is appropriate, accessible and effective. The present paper explores informal caregivers' and recipients' relationships with formal support, drawing on thematic and narrative analysis of 30 in-depth interviews with self-identified family caregivers conducted over a year in a mid-size city in Ontario, Canada. All but six of these caregivers had had some interaction with formal support. The semistructured interviews explored caregivers' knowledge about, and perceptions and experiences of accessing and using formal support. Interpretation reveals how confusion and lack of knowledge about services, the inflexibility and lack of availability of services, and increasing pressure on the quantity and quality of publicly funded community-based resources combine to impact negatively on the experience of accessing and using formal support. Different ideas about the relative roles and responsibilities of seniors, informal caregivers and 'family' in general, and the state both shape and are shaped by policies and the situated realities of the provision of formal support. Providing care at home creates both opportunities and constraints for caregivers in their interactions with formal support. Lastly, this paper highlights the difficulties of interacting with publicly funded formal support as the costs of care are moved away from the state and onto families and individuals.