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Understanding health care utilization of older adults with Parkinson’s disease in Taiwan - Role of psychological variables

Leu, Yii-Rong

German Title: Inanspruchnahme medizinischer und pflegerischer Versorgungsleistungen bei älteren Parkinson Patienten in Taiwan - Rolle psychologischer Variablen

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Aims: As a common neurodegenerative chronic illness in old age, Parkinson’s disease (PD) is a leading reason of long-term health care utilization. While the multifaceted economic concerns in this disorder are internationally well documented, the psychological aspects have not received the same attention. The present study, based on a modified Andersen model, aimed at improving the understanding of predictors addressing health care utilization among a sample of older Taiwanese adults with PD, specifically exploring the role of the psychological component and investigating the relationships between depressive symptoms, health care utilization and health-related quality of life (HRQOL). The specific goals of the present research project were to (1) get an insight into the characteristics of health care utilization in PD; (2) test a modified Andersen model with additional psychological variables such as knowledge, attitudes, the social norms and perceived control; (3) establish path models predicting differentiated types of health care utilization examined in this study; and to (4) explore the relationships between health care utilization, depressive symptoms and HRQOL among a sample of older Taiwanese adults with PD. Methods: This study was conducted in Taipei, Taiwan, in 2009, using a cross-sectional design and a questionnaire orally administered to 284 persons with PD aged 65 and over, who had been recruited via location sampling in four outpatient clinic settings. A final useable response rate of 70.4 per cent was achieved, which included a sample of 200 participants, consisting of 104 males (52%) and 96 females (48%). Statistical description and logistic regression analysis in SPSS Version 16 and path analysis in LISREL Version 8.72 were conducted for the data analysis. Results: Visits to hospital out-patient departments were found to be the most utilized health care service (approximately 70%), followed by prescription refill slips (52.5%), supportive devices (55.5%) and family care (48%). According to logistic regression analysis, the modified Andersen model showed a good fit with the data and accounted for between 23.6% and 53.4% of the variance (Negelkerke R2). Need was indicated to be the most significant risk factor. It is to be noted that risk factors concerning the utilization of single service were suggested to vary from service to service, depending on the service being measured. Moreover, based on an ‘aggregate’ approach (single services had been aggregated into four types of services), path analysis revealed significant effects of need, followed by the psychological and predisposing components. Addressing the utilization of medical and care services, the role of psychological variables turned out to be significant. In detail, ADL, attitudes towards health care and age were indicated to have total effects on the utilization of medical services; ADL, age, education level, selective and compensatory control were significantly linked to the utilization of care services. In regards with HRQOL among older adults with PD, the findings indicated that selective control and ADL had positive total effects on HRQOL, whereas co-morbidity, age and education level were negatively linked to HRQOL. Additionally, the utilization of care services was proved to have negative total effects on HRQOL. Moreover, once depressive symptoms were taken into consideration, depressive symptoms, age, co-morbidity, education level, ADL and selective control were suggested to be significantly linked to HRQOL. Particularly, high levels of depressive symptoms were more likely to be associated with an increasing utilization of medical and care services. Additionally, the utilization of care services was proved to have negative total effects on HRQOL. Indirect effects on HRQOL and a complex interplay inherent in the modified behavioral model were also identified. Conclusion: Next to need, the psychological variables in the modified Andersen model were proved to have total effects on health care utilization. Health care services were recommended to be categorized into different types with the aim of extending the understanding of multifaceted health care utilization and HRQOL in PD. Moreover, the impacts of selective control, depressive symptoms and the utilization of care services on HRQOL were identified. Accordingly, screening and treatment for depression and implementing behavioral intervention programs with the concept of perceived control were likely to improve HRQOL among the older adults with PD.

Translation of abstract (German)

Hintergrund: In den kommenden Jahrzehnten ist mit einem starken Zuwachs an älteren Menschen, die an Parkinson erkranken und ihrem steigenden Bedarf an gesundheitlicher Versorgung zu rechnen. Bislang liegen jedoch nur wenige Versorgungsstudien hinsichtlich psychologischer Aspekte vor. Zielsetzung: Ziele dieser Studie waren die Ermittlung der Inanspruchnahme medizinischer und pflegerischer Versorgungsleistungen und deren Einflussfaktoren bei älteren Parkinson-Patienten und die Überprüfung der Zusammenhänge zwischen der Inanspruchnahme von Versorgungsangeboten, gesundheits-relevanter Lebensqualität und depressiver Symptome. Methode: Die theoretische Grundlage der Studie basiert auf dem renommierten Andersen-Modell der Inanspruchnahme von Versorgungsleistungen, modifiziert mit psychologischen Variablen wie Einstellung, Wissen, soziale Normen und wahrgenommene Kontrolle. Eine Fragebogenstudie (n=200) in Taipei (Taiwan) wurde konzipiert. Wechselbeziehungen zwischen ermöglichenden Ressourcen, prädisponierenden, bedarfsdefinierenden und psychologischen Variablen wurden mittels logistischer Regressionsanalysen und Pfadanalysen identifiziert. Ergebnisse: Die Ergebnisse weisen darauf hin, dass eine ambulante Vorstellung im Krankenhaus (69%) das häufigste in Anspruch genommene Versorgungsangebot ist, gefolgt von Rezepten für chronisch Erkrankte, Hilfsmitteln und familiärer Pflege. Logistische Regressionsanalysen zeigen, dass (1)sich die signifikanten Einflussvariablen je nach Versorgungsleistung unterscheiden und (2)soziale Normen und wissensbezogene Variablen – neben den starken bedarfsdefinierenden Variablen – eine bedeutende Rolle in der Nutzung der Einzelversorgung spielen. Bezüglich der Inanspruchnahme der gesamten Versorgungsangebote wurde Ko-Morbidität als einzig signifikante Variable identifiziert. Wenn die Gesamtheit aller überprüften Versorgungsangebote in medizinische und pflegerische Leistungen unterteilt wird, kommen weitere signifikante Einflussfaktoren zum Vorschein, z.B.: (1)ADL zeigt den höchsten direkten Effekt auf die Inanspruchnahme beider Leistungstypen; (2)Alter übt sowohl direkte als auch indirekte Effekte aus auf die Inanspruchnahme der beiden Leistungstypen; (3)Einstellung zur Versorgung steht in positivem Zusammenhang mit der Inanspruchnahme medizinischer Versorgungsangebote; (4)Selektive und kompensatorische Kontrolle stehen in negativem Zusammenhang mit der Inanspruchnahme pflegerischer Angebote. Im Hinblick auf die gesundheitsrelevante Lebensqualität (HRQOL) der Parkinson-Patienten lässt sich folgendes feststellen. (1)Selektive Kontrolle zeigt starke positive Effekte auf HRQOL; (2)Inanspruchnahme pflegerischer Versorgung weist negative Effekte auf HRQOL auf; (3)Depressivität übt stärkere Effekte auf HRQOL aus; und (4)Positive Zusammenhänge bestehen zwischen depressiven Symptomen und Inanspruchnahme beider Versorgungstypen. Schlussfolgerung: (1)Depressivität der Parkinson-Patienten soll diagnostiziert und behandelt werden; (2)Interventionsprogramme bezüglich Kontrollstrategie-Training und Patientenedukation sollen in die Praxis integriert werden. Dies kann HRQOL der Parkinson-Patienten erhöhen; (3)für die weiterführende Forschung ist zu empfehlen: Unterteilung der Versorgungsangebote und Miteinbeziehen psychologischer Variablen.

Item Type: Dissertation
Supervisor: Wahl, Prof. Dr. Hans-Werner
Date of thesis defense: 21 August 2012
Date Deposited: 11 Sep 2012 09:17
Date: 2012
Faculties / Institutes: The Faculty of Behavioural and Cultural Studies > Institute of Psychology
Subjects: 150 Psychology
Controlled Keywords: Inanspruchnahme, medizinische Versorgung, Parkinson-Krankheit, Lebensqualität, Depressivität
Uncontrolled Keywords: health care utilization , Parkinson’s disease , health-related quality of life , older adults , control strategies , depression
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