An ecological study of factors related to the volume of home visit care

• Published in: Review of Japan Society of Health Support Science Vol. 8; pp. 81 - 92
• Main Authors: MURAMATSU, Keiji, LIU, Ning, FUJIMOTO, Kenji, MATSUDA, Shinya, NOMOTO, Yumi
• Format: Journal Article
• Language: Japanese
• Published: Japan Society of Health Support Science 2023; 日本ヘルスサポート学会
• Subjects: aging society; health care Planning; Home-visit medical care; 医療計画; 訪問診療; 高齢社会
• ISSN: 2188-2924
• DOI: 10.14964/hssanj.8.81

Purpose: The regional healthcare concept issued in 2018 aims to increase the amount of home medical care. However, the amount of home medical care is affected by various factors such as the state of medical and long term care services in each region, human resources, and living environment. It is practical to consider how home medical care should be based on these regional characteristics. Therefore, in this analysis, we conducted an ecological study on the factors related to the amount of home-visit medical care using medical care-related data by secondary medical care area.Method: Using SCR （standardized claim-data ratio） published on the Cabinet Office “Economic, Financial and Living Index ‘Visualization’ Portal Site” and “Regional Differences in Medical Care Provisions”, Ministry of Health, Labor and Welfare, Long Term Care Insurance Business Status Report, and the data of the number of specific facilities in the Japan Medical Association Regional Medical Information System, we created a data set for each secondary medical area, and performed correlation analysis and covariance structure analysis between variables.Results: In the secondary medical area, where a large amount of home-visit medical care is provided, a large amount of outpatient medical care, home-visit nursing, home care services, and many emergency home visits and emergency care conferences are held. Furthermore, in areas where the capacity of specific facilities such as facilities for the elderly with care services is large, the amount of home-visit medical care provided was large. A significant negative correlation was observed between the amount of home-visit medical care provided and admission to nursing homes, but no significant correlation was observed for long-term care beds. Based on the above results, we constructed a model between variables and conducted a covariance structure analysis. As a result, the amount of care provided by nursing homes and inpatients was negatively related to the amount of medical care provided by home visits. There was a significant positive correlation between the medical care support system, the emergency response system, and the amount of housing for the elderly with services.Discussion: In order to promote home visits, it is first necessary to have medical institutions such as clinics and visiting nursing service. In addition, the results of this analysis show that home medical care is substitutable for institutional long-term care services, and that it is important to have homes that are easy to receive long-term care, such as specific facilities, in order to increase the amount of care provided.Conclusion: In order to promote home medical care, it is important not only to improve medical and long term care services, but also to improve the living environment to promote it.