Differences in the healthcare needs of older adults attending primary health centers in urban and rural areas of Taiwan
Tóm tắt
As the older adult population in Taiwan continues to increase, primary health centers (PHCs) play a crucial role in geriatric care. This study explored the differences in the PHC experiences and usage needs of older adults in urban versus rural areas. A qualitative study was conducted. Twenty-one older adults were recruited from PHCs in northern, central, southern, and eastern Taiwan. Semistructured interviews were used to collect data, and the interview guidelines included their reasons for visiting PHCs, the health-care services they received, their evaluation of the services, and the advantages and disadvantages of these centers. The data were analyzed using thematic content analysis. The PHC usage needs of older adults in urban areas differ from those of older adults in rural areas in the following 3 aspects: (1) Medical services: older adults in rural areas demand clinics specializing in various medical domains, mobile and home medical care, and case management, whereas those in urban areas demand mobile health examinations. (2) Environment and transportation: older adults in rural areas demand diverse medical equipment, shuttle services, and accessible facilities, whereas those in urban areas demand recreational facilities. (3) Active aging: older adults in rural areas demand health education courses, and those in urban areas demand diverse senior citizen courses as well as opportunities to volunteer and build interpersonal relationships. The older adults in urban and rural areas had different PHC usage needs. The older adults in rural areas generally focused on medical care and transportation services in PHCs, whereas those in urban areas generally focused on health promotion as a means of social participation and active aging.
Tài liệu tham khảo
United Nations. World Population prospects 2019: highlights. United Nations; 2019. https://doi.org/10.18356/13bf5476-en.
Lin YY, Huang CS. Aging in Taiwan: building a society for active aging and aging in place. Gerontologist. 2016;56(2):176–83. https://doi.org/10.1093/geront/gnv107.
National Health Insurance Administration, Ministry od Health and Welfare. NHI MediCloud System application and results. 2018. Availabe at: https://www.nhi.gov.tw/English/Content_List.aspx?n=02BA04454AED80E0&topn=BCB2B0D2433F6491. Accessed on 9 Auguster 2022.
Prince MJ, Wu F, Guo Y, et al. The burden of Disease in older people and implications for health policy and practice. Lancet. 2015;385(9967):549–62. https://doi.org/10.1016/S0140-6736(14)61347-7.
Sin CK, Fu SN, Tsang CS, Tsui WW, Chan FH. Prevention in primary care is better than cure: the Hong Kong reference framework for preventive care for older adults–translating evidence into practice. Hong Kong Med J. 2015;21(4):353–9. https://doi.org/10.12809/hkmj144326.
Food, Bureau H, Kong H. Hong Kong reference framework for preventive care for older adults in primary care settings. The govemment of the Hong Kong Special Administrative Region, 2018. Availabe at: https://www.healthbureau.gov.hk/pho/rfs/english/reference_framework/pre_care_for_older_adults.html. Accessed on 9 Auguster 2022.
Shih CI, Hsu YH, Yang HF, et al. Development of an age-friendly health service recognition framework for primary health centers in Taiwan. Int J Gerontol. 2021;15(1):58–63. https://doi.org/10.6890/IJGE.202101_15(1).0012.
Woo J, Mak B, Yeung F. Age-friendly primary health care: an assessment of current service provision for older adults in Hong Kong. Health Serv Insights. 2013;6:69–77. https://doi.org/10.4137/HSI.S12434.
Chen CC, Chen LW, Cheng SH. Rural-urban differences in receiving guideline-recommended Diabetes care and experiencing avoidable hospitalizations under a universal coverage health system: evidence from the past decade. Public Health. 2017;151:13–22. https://doi.org/10.1016/j.puhe.2017.06.009.
Ding H, Chen Y, Yu M, et al. The effects of chronic Disease management in primary health care: evidence from rural China. J Health Econ. 2021;80:102539. https://doi.org/10.1016/j.jhealeco.2021.102539.
Liao PA, Chang HH, Yang FA. Does the universal health insurance program affect urban-rural differences in health service utilization among the elderly? Evidence from a longitudinal study in Taiwan. J Rural Health. 2012;28(1):84–91. https://doi.org/10.1111/j.1748-0361.2011.00363.x.
Ko PC, Yeung WJ. An ecological framework for active aging in China. J Aging Health. 2018;30(10):1642–76. https://doi.org/10.1177/0898264318795564.
Hu X, Wei Y, Tang J. Design strategy of friendly and healthy environment for urban aging community. IOP Conference Series: Earth and Environmental Science 2020;598(1):012044. https://doi.org/10.1088/1755-1315/598/1/012044.
Ministry of Health and Welfare. Senior Citizens Welfare Act, Taiwan. 2021. Availabe at: https://law.moj.gov.tw/ENG/LawClass/LawAll.aspx?pcode=D0050037. Accessed on9 August 2022.
Friese S, Soratto J, Pires D. Carrying out a computer-aided thematic content analysis with ATLAS.ti. MMG Working Paper 2018;18 – 02.
Kaminski T, Pitney W. Strategies for establishing trustworthiness in qualitative research. Athletic Therapy Today. 2004;9:26–8. https://doi.org/10.1123/att.9.1.26.
Mariolis A, Mihas C, Alevizos A, et al. Comparison of primary health care services between urban and rural settings after the introduction of the first urban health centre in Vyronas, Greece. BMC Health Serv Res. 2008;9(8):124. https://doi.org/10.1186/1472-6963-8-124.
Wulandari RD, Laksono AD. Urban-rural disparity: the utilization of primary healthcare centers among elderly in East Java, Indonesia. Indonesian J Health Adm. 2019;7(2):147–54. https://doi.org/10.20473/jaki.v7i2.2019.147-154.
Grol SM, Molleman GRM, Kuijpers A, et al. The role of the general practitioner in multidisciplinary teams: a qualitative study in elderly care. BMC Fam Pract. 2018;19(1):40. https://doi.org/10.1186/s12875-018-0726-5.
Lu KY, Lin PL, Tzeng LC, Huang KY, Chang LC. Effectiveness of case management for community elderly with Hypertension, Diabetes Mellitus, and hypercholesterolemia in Taiwan: a record review. Int J Nurs Stud. 2006;43(8):1001–10. https://doi.org/10.1016/j.ijnurstu.2005.11.013.
Gibson BA, Ghosh D, Morano JP, Altice FL. Accessibility and utilization patterns of a mobile medical clinic among vulnerable populations. Health Place. 2014;28:153–66. https://doi.org/10.1016/j.healthplace.2014.04.008.
Powell SK, Tahan HM. Case Management: a practical guide for education and practice. Wolters Kluwer Health; 2018.
Ministry of Health and Welfare. Optimize the rural medical improvement program. Taiwan; 2019. Availabe at: https://www.mohw.gov.tw/dl-59256-f6313189-2dc8-4c5e-9142-b014e1c5b6a2.html. Accessed on 9 June 2022.
Health Promotion Administration, Ministry of Health and Welfare. Guidelines for Community Integrated Screening. Taiwan. ; 2003. Availabe at: https://www.hpa.gov.tw/Pages/ashx/File.ashx?FilePath=~/File/Attach/1214/File_1693.odt. Accessed on 9 June 2022.
Ministry of health and welfare. Reference standard for organizational regulations of health centers affiliated to county and city health bureaus. Taiwan; 2000. Availabe at: https://www.hpa.gov.tw/Pages/ashx/File.ashx?FilePath=~/File/Attach/930/File_1322.odt. Accessed on 14 May 2022.
Joo JY, Huber DL. An integrative review of nurse-led community-based case management effectiveness. Int Nurs Rev. 2014;61(1):14–24. https://doi.org/10.1111/inr.12068.
Yeh WY, Chen CS, Zou XY, Liu YH, Wu BH, Taso YC, et al. A comparison of the utilization of and needs for primary healthcare services among residents in non-remote and remote areas of Hualien county. Taiwan J Public Health. 2012;31(4):371–87. https://doi.org/10.6288/TJPH2012-31-04-08.
Executive Yuan. Optimize rural medical care - make distance no longer distance. Taiwan. ; 2020. Availabe at: https://www.ey.gov.tw/Page/5A8A0CB5B41DA11E/341cd1dc-b6bf-4364-bb17-80f501d3ab90. Accessed on 15 May 2022.
Executive Yuan. Promote four upgrading strategies to transform primary health centers into community health care management centers. Taiwan. ; 2021. Availabe at: https://www.ey.gov.tw/Page/9277F759E41CCD91/d67b6723-3fb5-4cf9-ad6c-0c24ef3e54c4. Accessed on 15 My 2022.
Fernández-Ballesteros R. Active aging: the contribution of psychology. Hogrefe & Huber Publishers; 2008.
Radovan M, Krašovec SJ. Older men Learning in the community: European snapshots. Ljubljana University Press, Faculty of Arts and University of Algarve; 2014.
Health Promotion Administration. Ministry of Health and Welfare. 5D bridging the health gap 5D project results presentation on the research and development of long-distance smart silver hair technology interactive platform. Taiwan; 2021. Accessed on 9 Auguster 2022. https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=4306&pid=14723.
Piercy G. Transformative learning theory and spirituality: a whole-person approach. J Instructional Res. 2013;2:30–42. https://doi.org/10.9743/JIR.2013.2.14.
Kwok YY, Chui WH, Wong LP. Need satisfaction mechanism linking volunteer motivation and life satisfaction: a mediation study of volunteers subjective well-being. Soc Indic Res. 2013;114(3):1315–29. https://doi.org/10.1007/s11205-012-0204-8.