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首页> 外文期刊>International Journal of Integrated Care >Caregiver needs and formal long-term care service utilization in the Andersen Model: An individual-participant systematic review and meta-analysis
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Caregiver needs and formal long-term care service utilization in the Andersen Model: An individual-participant systematic review and meta-analysis

机译：安徒生模型中的看护者需求和正式的长期护理服务利用：个人参与者的系统评价和荟萃分析

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The aims of this study were to (i) provide precision on the existence, magnitude and direction of the relationship between informal caregiver needs – burden, health status and depression, and formal long-term care service (LTCS) utilization, (ii) provide evidence to support caregiver training programmes, and (iii) propose a new model of factors for formal LTCS utilization. Electronic searches of major scientific databases such as MEDLINE and PsycINFO, and hand-searches of ProQuest were conducted. Studies were included if they used the Andersen Model to guide variables selection, collected data directly from caregivers, and had the use of at least one LTCS as a criterion variable. Studies that did not report data required for meta-analyses were excluded. Separate meta-analyses were conducted for each of the three predictors. The effect size was the magnitude difference in any one predictor between LTCS users and non-users. Pearson correlation coefficients were extracted or calculated for each study and combined using appropriate effects models. Of the 40 studies identified, 18 were excluded upon abstract screening and a further 14 were excluded upon full-text screening. Of the remaining seven studies, six were reported in journal articles, and one in a dissertation. Of these seven studies, four had American, one had Mexican American, one had Canadian, and one had Australian participants. The final sample included a total of 1,073 caregivers with a range of mean ages from 47.9 to 80.3 years. Using random effects models, the combined unadjusted Pearson rs between LTCS use and caregiver burden (n = 4), health (n = 3) and depression (n = 4) were modest – .08 (p = .003), .08 (p = .031), and .09 (p = .193) respectively. The confidence intervals were .03 to .13, .01 to .15, and -.08 to .25 respectively. The effect of caregiver burden on LTCS use was homogeneous, Q = 2.66, p = .448, I2 = 0.00%. The effect of caregiver health on LTCS use was also homogeneous, Q = 2.80, p = .247, I2 = 28.5%. The effect of depression on LTCS use, however, was heterogeneous, Q = 24.23, p .001, I2 = 87.6%. Moderator analyses found that mean caregiver age did not influence the effect of caregiver depression on LTCS use, β = .56, p = .341. No publication bias was found in both the homogeneous effects. Within the Andersen Model, higher caregiver burden and poorer caregiver health are related to a modest, albeit real, increase in LTCS use. Integrated LTCS design should consider the caregiver. Caregiver training programmes aimed at addressing caregiver burden and health status should be a part of LTCS. The Andersen Model, when expanded to include caregiver needs, is potentially a useful framework that may guide LTCS and integrated care utilization. Although the sample was small, this was the first systematic review and meta-analyses of the effect of self-reported caregiver needs - burden, health and depression - on LTCS use within the Andersen Model. The PRISMA-P adapted protocol of this unfunded study is available from the first author.
机译：这项研究的目的是（i）提供有关非正式护理人员需求（负担，健康状况和抑郁）与正式长期护理服务（LTCS）利用之间关系的存在，程度和方向的精确信息，（ii）提供支持照料者培训计划的证据;（iii）为正式的LTCS利用提出一种新的因素模型。对主要科学数据库（如MEDLINE和PsycINFO）进行了电子搜索，并对ProQuest进行了手动搜索。如果他们使用Andersen模型来指导变量选择，直接从看护者那里收集数据并使用至少一个LTCS作为标准变量，则将其纳入研究。排除未报告荟萃分析所需数据的研究。对这三个预测因素分别进行了荟萃分析。效果大小是LTCS用户与非用户之间任何一种预测变量的大小差异。为每个研究提取或计算Pearson相关系数，并使用适当的效应模型进行组合。在确定的40项研究中，摘要筛选排除了18项，全文筛选排除了另外14项。在其余的七项研究中，有六篇发表在期刊文章中，另一篇发表在论文中。在这七项研究中，有四项是美国人，一项是墨西哥人，一项是加拿大人，另一项是澳大利亚人。最终样本包括总共1,073名护理人员，平均年龄范围为47.9至80.3岁。使用随机效应模型，LTCS使用与照顾者负担（n = 4），健康（n = 3）和抑郁（n = 4）之间未经调整的Pearson rs分别为-.08（p = .003）、. 08（ p = .031）和.09（p = .193）。置信区间分别为.03至.13，.01至.15和-.08至.25。照顾者负担对LTCS使用的影响是均匀的，Q = 2.66，p = .448，I2 = 0.00％。照护者健康对LTCS使用的影响也很均匀，Q = 2.80，p = .247，I2 = 28.5％。然而，抑郁症对LTCS使用的影响是异质的，Q = 24.23，p <.001，I2 = 87.6％。主持人分析发现，平均照护者年龄不影响照护者抑郁对LTCS使用的影响，β= .56，p = .341。两种均质效应均未发现偏倚。在安徒生模型中，较高的照料者负担和较差的照料者健康与LTCS使用量的适度增加（尽管是实际的）有关。集成的LTCS设计应考虑照料者。旨在解决护理人员负担和健康状况的护理人员培训计划应成为LTCS的一部分。当将Andersen模型扩展到包括护理人员的需求时，它可能是一个有用的框架，可以指导LTCS和综合护理使用。尽管样本量很小，但这是首次自我审查的照护者需求（负担，健康和抑郁）对安徒生模型中LTCS使用的影响的系统评价和荟萃分析。这项未获资助的研究的PRISMA-P适应方案可从第一作者那里获得。

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