Medical care needs for patients receiving home healthcare in Taiwan: Do gender and income matter?

Studies about medical care needs for home healthcare (HHC) previously focused on disease patterns but not gender and income differences. We used the Taiwan National Health Research Insurance Database from 1997 to 2013 to examine trends in medical care needs for patients who received HHC, and the gender and income gaps in medical care needs, which were represented by resource utilization groups (RUG). We aimed to clarify three questions: 1. Are women at a higher level of medical care needs for HHC than men, 2. Does income relate to medical care needs? 3. Is the interaction term (gender and income) related to the likelihood of medical care needs? Results showed that the highest level of medical care need in HHC was reducing whereas the basic levels of medical care need for HHC are climbing over time in Taiwan during 1998 and 2013. The percentages of women with income-dependent status in RUG1 to RUG4 are 26.43%, 26.24%, 30.68%, and 32.07%, respectively. Women were more likely to have higher medical care needs than men (RUG 3: odds ratio, OR = 1.17, 95% confidence interval, CI = 1.10-1.25; RUG4: OR = 1.13, 95% CI = 1.06-1.22) in multivariates regression test. Compared to the patients with the high-income status, patients with the income-dependent status were more likely to receive RUG3 (OR = 2.34, 95% CI = 1.77-3.09) and RUG4 (OR = 1.98, 95% CI = 1.44-2.71). The results are consistent with the perspectives of fundamental causes of disease and feminization of poverty theory, implying gender and income inequalities in medical care needs. Policymakers should increase public spending for delivering home-based integrated care resources, especially for women with lower income, to reduce the double burden of female poverty at the higher levels of medical care needs for HHC.

[Assessment of the quality of randomized controlled trials in treating coronary heart disease by Chinese patent medicine].

OBJECTIVE: To assess the quality of randomized controlled trials (RCTs) on Compound Danshen Dripping Pill, Compound Danshen Tablet, Suxiao Jiuxin Pill, Tongxinluo Capsule, and isosorbide dinitrate (ISDN) in treating coronary heart disease angina. METHODS: RCT reports were retrieved from CNKI, Wanfang Data, PubMed, China Master Theses Full-text Database, Chinese Electronic Periodical Services, Social Sciences Citation Index, Science Direct, Cambridge Journals Online, and EBM Reviews. Qualities of RCTs were assessed according to Jadad scale, M scale, CONSORT 2010, and CONSORT for herbal medicine. Kendall correlations between basic study characteristics and qualities of included RCTs were analyzed using R statistical software. RESULTS: Eighty-eight RCTs were included. The medians (means, 95% CIs) were 2.00 (2.09, [1.81,2.37]) for the Jadad scale, 4.00 (3.52,[2.95, 4.09]) for the M scale, 15.00 (15.39, [13.87, 16.91]) for the CONSORT 2010, and 19.00 (19.06,[17.16, 20.96]) for the CONSORT for herbal medicine. Only 9.09% (8/88) of RCTs were of high quality (Jadad score >2). These RCT quality measures were not correlated with individual items of reporting, such as sample sizes and follow-up periods. CONCLUSIONS: The quality of RCTs on Chinese patent medicine compared with ISDN was not improved from 1997 to 2009. It is urgent to improve the design of RCTs and the report quality.