Short-term effects of comprehensive caregiver supports on caregiver outcomes.
Short-term effects of comprehensive caregiver supports on caregiver outcomes.
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综合护理人员支持对护理人员结果的短期影响。
DOI：
10.1111/1475-6773.14038
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发表时间：
2023
影响因子：
3.4
通讯作者：
Stearns,SallyC
中科院分区：
文献类型：
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作者：
Miller,KatherineEM;VanHoutven,CourtneyH;Kent,ErinE;Gilleskie,Donna;Holmes,GMark;Smith,ValerieA;Stearns,SallyC
目的评估2011年退伍军人健康管理局（VHA）实施的家庭照顾者综合援助计划（PCAFC）与照顾者健康和医疗保健使用的关系。数据来源2009年5月至2018年5月vha索赔和电子健康记录。研究设计采用回顾性、前后研究设计，采用治疗权重的逆概率来解决治疗选择问题，我们研究了PCAFC与退伍军人护理人员的关系：(1)门诊、初级、专科和精神卫生保健就诊；(2)高血压和焦虑/抑郁不受控制的概率；(3) VHA医疗费用。我们比较了批准PCAFC（治疗）和拒绝PCAFC（比较）的护理人员的结果。数据收集/提取方法不适用。在申请前一年，我们观察到VHA初级护理（~36%），VHA专科护理（~24%），以及VHA或VHA购买的心理健康护理（~22%）的治疗和比较护理者的概率相似。在申请后的一年中，接受治疗的护理人员接受任何门诊VHA初级保健的可能性高出5.89个百分点（p= 0.002），任何门诊精神卫生保健使用的可能性高出4.34个百分点（p= 0.014）。应用后，治疗组和对照组患未控制的高血压或诊断为焦虑/抑郁的可能性更高。在申请后的第二年，接受治疗的护理人员高血压不受控制的概率高出1.88个百分点（p= 0.019），被诊断为焦虑/抑郁的概率高出4.68个百分点（预测概率：治疗= 0.30；比较= 0.25;p= 0.005）。我们没有发现VHA总成本因PCAFC状态而有差异的证据。结论：我们的研究结果表明，PCAFC的加入与医疗保健诊断和服务使用的增加有关，这可能反映了PCAFC退伍军人护理人员改善了以前未满足的需求。这些增加的成本和价值可以与该计划的其他影响进行权衡，为支持护理人员的国家政策提供信息。
ObjectiveTo estimate the association of the Veterans Health Administration (VHA) Program of Comprehensive Assistance for Family Caregivers (PCAFC) implemented in 2011 with caregiver health and health care use.Data SourcesVHA claims and electronic health records from May 2009 to May 2018.Study DesignUsing a retrospective, pre–post study design with inverse probability of treatment weights to address selection into treatment, we examine the association of PCAFC on caregivers who are veterans: (1) outpatient primary, specialty, and mental health care visits; (2) probability of uncontrolled hypertension and anxiety/depression; and (3) VHA health care costs. We compare outcomes for caregivers approved for PCAFC (treatment) to caregivers denied PCAFC (comparison).Data Collection/Extraction MethodsNot applicable.Principal FindingsIn the year pre‐application, we observe similar probabilities of having any VHA primary care (~36%), VHA specialty care (~24%), and VHA or VHA‐purchased mental health care (~22%) for treatment and comparison caregivers. In the year post‐application, treated caregivers had a 5.89 percentage point larger probability of any outpatient VHA primary care (p= 0.002) and 4.34 percentage points larger probability of any outpatient mental health care use (p= 0.014). Post‐application, probabilities of having uncontrolled hypertension or diagnosed anxiety/depression were higher for both treated and comparison groups. In the second year post‐application, treated caregivers had a 1.88 percentage point larger probability of uncontrolled hypertension (p= 0.019) and 4.68 percentage points larger probability of diagnosed anxiety/depression (predicted probabilities: treated = 0.30; comparison = 0.25;p= 0.005). We find no evidence of differences in VHA total costs by PCAFC status.ConclusionsOur findings that PCAFC enrollment is associated with increased health care diagnosis and service use may reflect improved access for previously unmet needs in the population of veteran caregivers for veterans in PCAFC. The costs and value of these increases can be weighed against other effects of the program to inform national policies supporting caregivers.