Korean primary health care program for people with disabilities: do they really want home-based primary care?

BACKGROUND

Despite many studies on home-based primary care (HBPC)-related benefits and challenges, little is known about the perspectives of potential target groups of the care and their intention or preference for using it. This study aimed to explore the demand for HBPC from the perspective of people with disabilities (PWDs) and caregivers and identify relevant determinants for that demand.

METHODS

Data from the population-based survey conducted in the Gyeonggi Regional Health & Medical Center for People with Disabilities in South Korea were analyzed. Logistic regression analysis was performed to identify relevant determinants for the demand on HBPC.

RESULTS

Overall, 22% of respondents required HBPC, and 34.7% of persons aged ≥ 65 years demanded it. Older adults with disability, homebound status, and a need for assistance with daily living activities were associated with a demand for HBPC. Though having severe disability, only 19.49% of self-reported respondents demanded for HBPC, while 39.57% of proxy-reported respondents demanded for HBPC. Among self-reported group, only marital status was a predictor associated with a demand for HBPC. In contrast, among proxy-reported groups, PWDs with external physical disabilities, or with unmet medical needs due to availability barriers reported a higher demand for HBPC.

CONCLUSIONS

The demand for HBPC does not derive from the medical demands of the users themselves, but rather the care deficit by difficulty in getting out of the house or in outpatient care. Beyond an alternative to office-based care, HBPC needs to be considered to solve the care deficit and as well as to deal with PWDs' medical problems.

Association of Home-Based Primary Care Enrollment with Social Determinants of Health for Older Veterans

BACKGROUND

Home-based Primary Care (HBPC) provides comprehensive primary care to Veterans who may be at risk of adverse health outcomes due to their social determinants of health. Area Deprivation Index (ADI) can be used as a surrogate measure of a Veteran's social needs.

OBJECTIVE

To estimate the effect of neighborhood disadvantage, as measured by ADI, on HBPC enrollment for a sample of Veterans.

METHODS

We estimated a linear multivariate model in which the exposure was ADI and the outcome was enrollment in HBPC. Controls included clinical and demographic characteristics.

RESULTS

In a final sample of 12,005,453 observations (total Veteran months) on 353,485 individual Veterans, 18.4% lived in high-deprivation neighborhoods (ADI greater than 80). Mean monthly probability of new HBPC enrollment was 0.0061. Controlling for clinical characteristics, housing instability, and distance from the medical center, Veterans residing in high-deprivation neighborhoods were 1.4% to 14.8% less likely to enroll in HBPC, though the association was not statistically significant.

CONCLUSIONS

More research is needed to determine the relationship between Veterans' social needs and HBPC enrollment.

Factors Associated With Hospitalization by Veterans in Home-Based Primary Care

OBJECTIVES

This study examined the extent to which program site-based and Veteran characteristics were associated with potentially avoidable hospitalizations or other hospitalization of Veterans enrolled in the Veterans Affairs (VA) Home-Based Primary Care (HBPC).

DESIGN

Retrospective claims-based study.

SETTING AND PARTICIPANTS

HBPC programs that responded to a national survey of HBPC programs (n = 189) in fiscal year (FY) 2016 were studied. Veterans in the analysis cohort were identified as having been enrolled in VA-HBPC in FY2016 who had not received care by VA-HBPC within 1 year prior to their first HBPC enrollment in FY2016 (N = 8497).

METHODS

Multinomial logistic regression analysis with 5 outcome categories within the 6 months following the first HBPC enrollment date: (1) any potentially avoidable hospitalizations for ambulatory care-sensitive conditions (ACSC) as identified by AHRQ Prevention Quality Indicator (PQI), (2) any other hospitalizations for non-ACSC conditions, (3) died during study period, (4) discharged from HBPC, or (5) remained at home with HBPC. Average marginal effects (AME) of veteran-level and VA-HBPC-level covariates are reported for each of the outcome categories.

RESULTS

More frail Veterans and Veterans 85 years old or older were more likely to have potentially preventable ACSC hospitalizations (AME = 5.4%, 1.8%, respectively). Veterans who were younger than 75 years, functionally impaired, bed-bound, or frail were more likely to have non-ACSC hospitalization (AME = 3.0%, 2.2%, 3.5%, and 9.0%, respectively). Veterans with low frailty index scores were less likely to have non-ACSC hospitalizations (AME = -17.1%). Six-month hospitalization patterns were not associated with reported HBPC site characteristics.

CONCLUSIONS AND IMPLICATIONS

Within the framework of the national VA HBPC program, variations in the structural model used at HBPC sites are not significantly associated with hospitalizations. Tailoring of HBPC care, based on individual patient factors and clinical judgment rather than standard protocols, may be central to the success of HBPC in reducing ACSC hospitalizations.

VA Home Based Primary Care Teams: Partnering with and Acting as Caregivers for Veterans

The U.S. Department of Veterans Affairs' Home-Based Primary Care (HBPC) Interdisciplinary Team (IDT) provides in-home, primary care for medically complex Veterans. This study explores how HBPC and Veterans' caregivers partner to provide care. Interviews, focus groups, and field observations were conducted during eight HBPC site visits. Qualitative thematic analysis was performed. Caregivers/IDT member partnerships are important to care. Effective partnerships include: ease of communication; caregiver-centered support; and when no caregiver is present, IDTs providing more monitoring/services to Veterans and connection to community services. As this model expands, understanding dynamics between IDT members and caregivers will optimize the success of HBPC programs.

Who Are the People Willing to Pay for Physician Home Visits?

BACKGROUND

Since the recently announced Community Care Policy, there has been an opinion that Korea needs to establish an alternative medical model such as physician home visits. This study aimed to assess the need and willingness to pay (WTP) for physician home visits among the community-dwelling Korean older population and to determine the most important factors that influence older adults to decide to use a physician home visit service.

METHODS

A total of 797 people aged 60 years or older who were randomly selected from a nationwide dataset using a multi-stage stratified sampling method answered a questionnaire on the need and WTP for physician home visits.

RESULTS

A total of 39.3% of participants reported that they would like a physician home visit when they need help. Among older adults who needed physician home visits (n = 313), the WTP amount for physician home visits was 21,982 ± 17,546 KRW. Logit and Tobit regression analyses showed that the higher valuated need and WTP for physician home visits was associated with a lower level of physical/psychosocial functioning measured by EuroQol-five dimensions score (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.01-1.27; P = 0.035) and a higher level of satisfaction when using community-based services such as public health centers (OR, 1.32; 95% CI, 1.02-1.72; P = 0.034), social welfare centers and Gyeong-ro-dang (OR, 1.61; 95% CI, 1.04-2.50; P = 0.033; β = 8.39; standard error, 3.63; P = 0.021).

CONCLUSION

This study provides evidence that the decision to pay for a physician home visit service is based upon the complex interactions among an individual's physical and psychosocial functioning, personal experiences of service utilization, and demographic factors. The value for physician home visits should be qualified based on the empirical data of WTP, which comes from a consumer-centered perspective.