Impact of integrated health care on elderly population: A systematic review of Taiwan's experience.

BACKGROUND: Care fragmentation in the elderly population prompted the need for integrated health care systems. However, evidence regarding the impact of the integrated care system in Taiwan is unclear. We aimed to conduct a systematic review to evaluate the impact of Taiwan's integrated health care programs on geriatric population. METHODS: We searched bibliographic databases MEDLINE, Embase, Web of Science, and Airiti Library for relevant publications throughout May 2022. Studies investigating the effectiveness of Taiwan's integrated care programs were included. We used the critical appraisal skills programme (CASP) checklist, to assess the risk of bias of included studies. RESULTS: Thirty-four studies, with a total of 838,026 study subjects, were assessed. The systematic review on 11 subthemes (diabetes mellitus, chronic kidney disease, hepatitis C virus, fractures, cancer, dementia, atrial fibrillation, chronic obstructive pulmonary disease, mechanical ventilation, terminal illness, outpatients and community-dwelling patients), demonstrated that the implementation of integrated health care could not only provide benefits on survival, self-care ability, health quality, physical, and functional rehabilitation outcomes, but also significantly reduce medical utilization and expenditures. CONCLUSION: The integrated health care system for multiple morbidities benefits the Taiwanese geriatric population in physical and functional outcomes. The thematic synthesis provides references for future rigorous clinical trials.

Determinants and indicators of successful ageing associated with mortality: a 4-year population-based study.

Successful aging may be a solution to the major challenges that population aging poses to healthcare systems, financial security, and labor force supply. Hence, we studied the value of factors discovered by exploratory factor analysis in predicting four main indicators of successful aging, and their association with mortality. We followed-up a nationally representative sample of 1284 older adults for a median of 50 months. Successful aging was defined by fast walking, independence, emotional vitality, and self-rated health. Exploratory factor analysis revealed five determinants: physical activity, life satisfaction and financial status, health status, stress, and cognitive function. Physical activity and health status were significant factors in living independently. Life satisfaction and financial status were associated with walking speed. Stress was solely associated with emotional vitality. Life satisfaction and financial status, and health status, were important predictors of self-rated health. Compared to people without any successful aging indicators, those with one, two, three, or four showed dose-dependent lessening of mortality risk, with respective hazard ratios of 0.39 (95% CI 0.25-0.59), 0.29 (95% CI 0.17-0.50), 0.23 (95% CI 0.11-0.51), and 0.09 (95% CI 0.01-0.66). These associations were stronger in males, older adults, smokers, and drinkers, than in their counterparts.

Hypothyroidism and the Risk of Venous Thromboembolism: A Nationwide Cohort Study.

BACKGROUND: Previous studies have shown that hypothyroidism may have an impact on blood coagulation. However, how hypothyroidism and thyroxine replacement therapy (TRT) affect the risk of venous thromboembolism (VTE) remains controversial. This study aimed to examine the associations of hypothyroidism and TRT with VTE risks. MATERIALS AND METHODS: This nationwide population-based cohort study was conducted using Taiwan's National Health Insurance Research Database. We enrolled 10,818 hypothyroid patients (the exposed cohort) and 21,636 non-hypothyroid subjects (the unexposed cohort) between 2001 and 2014 after 1:2 exact matching according to age, sex, and index year. Hypothyroid patients were further divided into two groups depending on whether they received TRT or not. Adjusted hazard ratios (aHRs) for VTE were calculated using Fine and Gray competing risk models. RESULTS: The mean follow-up period was 7.5 years. Hypothyroidism was significantly associated with a higher risk of VTE (aHR = 1.83 [95% confidence interval [CI]: 1.44-2.33, p < 0.001]). Among hypothyroid patients, the TRT subgroup had a non-significant trend of lower VTE risk than the non-TRT subgroup (aHR = 0.73 [95% CI: 0.52-1.01, p = 0.058]). The analysis for individual events revealed a significant association between TRT use and a lower risk of pulmonary embolism among hypothyroid patients (aHR = 0.34 [95% CI: 0.13-0.88, p = 0.026]). CONCLUSION: The data suggest that hypothyroidism was significantly associated with an increased risk of VTE. Among hypothyroid patients, a non-significant trend of lower VTE risk in patients treated with TRT was observed. Further prospective studies or clinical trials are necessary to confirm causality.

Caregivers' reported functional limitations in activities of daily living among middle-aged adults with intellectual disabilities.

This study was conducted to describe the functioning of Activities of Daily Living (ADL) and to examine socio-economic effects on ADL functioning among adults with intellectual disabilities (ID) aged 45 years and older (N=480) in Taiwan. The Barthel Index (BI) was used to determine a baseline level of ADL functioning in the study participants. There are five categories of functional impairment using the following cut-off values in Taiwan: total dependence (BI score 0-20), severe (BI score 21-60), moderate (BI score 61-90), mild (BI score 91-99), and total independence (BI score 100) (Taiwan Department of Health, 2012). The results revealed that 2.3% of adults with ID were in total dependence, 11.9% were in severe dependence, 27.9% were in moderate dependence, 8.1% had a mild dependence, and 49.8% were totally independent. In the multiple linear regression model of the ADL score, we determined that educational level, comorbid Down's syndrome, and disability level are the variables able to significantly predict ADL score (R(2)=0.190) after controlling for the factors of age, marital status, and other comorbidity conditions. Those ID adults with a lower education level (primary vs. literate, ß=4.780, p=0.031; intermediate vs. literate, ß=6.642, p=0.030), with comorbid Down's syndrome (ß=-7.135, p=0.063), and with a more severe disability condition (severe vs. mild, ß=-7.650, p=0.007; profound vs. mild, ß=-19.169, p<0.001) had significantly lower ADL scores. The present study highlights the need to support mobility in older adults with ID as much as possible to optimize independence in this group.

Analysis of seasonal influenza vaccine uptake among children and adolescents with an intellectual disability.

The aim of the present study was to describe the seasonal influenza vaccination rate and to examine its determinants for children and adolescents with intellectual disabilities (ID) living in the community. A cross-sectional survey was conducted to analyze the data on seasonal influenza vaccination rate among 1055 ID individuals between the ages of 12-18 years. The results found that 22.9% of the study participants used the vaccine during the past three years, and the vaccination rate among different age groups varied from 18.1 to 26.5%. There was no gender difference of seasonal influenza vaccination rate among age groups. Multilevel logistic regression analysis revealed that ID individuals with moderate (OR = 1.59, 95% CI = 1.08-2.34) or severe (OR = 2.31, 95% CI = 1.20-4.45) disability, with an illness (OR = 1.64, 95% CI = 1.02-2.63), who have general health exams (ever used, OR = 1.57, 95% CI = 1.03-2.40; regularly used, OR = 1.89, 95% CI = 1.05-3.41) were more likely to have seasonal influenza vaccination than their counterparts. The present study highlights that the substantial disparity in receipt of seasonal influenza vaccine in children and adolescents with ID reflects the effects of disability level, disease condition, and general health exam experience and suggests the need for greater attention to factors affecting ID individuals to improve their preventive health care.

Determinants of prescription drug use by adolescents with intellectual disabilities in Taiwan.

Direct family caregivers of population-based adolescents with intellectual disabilities in Taiwan were surveyed regarding their perceptions of the use of prescribed medication and its relationship with health-related behaviors, medical care and preventive health utilization of people with intellectual disabilities. Cross-sectional data on 1419 adolescents 12-17 years of age was collected from the 2007 National Survey on Healthy Behaviors and Preventive Health Utilizations of People with Intellectual Disabilities in Taiwan. Multiple logistic regression models were used to examine risk profiles in relation to the use of prescribed medication and other relevant variables: participant characteristics, health-related behaviors, medical care and preventive health utilization. The results indicate that 47.1% of subjects were accompanied by other impairments, the morbidity prevalence was 16.5% and 23.8% of subjects were reported to have used prescribed medication regularly in the past 6 months. The main reasons for medication use were epilepsy (36.9%), psychiatric problems (24.2%) and gastrointestinal problems (6.3%). A large majority of caregivers reported that the subject's health status was excellent (15.4%), good (38%) or fair (38%), and only 6.5% were reported to be in bad health. Finally, data were analyzed using a logistic regression model to identify possible reasons for drug use. The following factors correlate with the regular use of prescribed medication by adolescents with intellectual disabilities: Down syndrome, possession of a Major Illness Card, a history of smoking, an additional impairment, reported health status, outpatient care and acceptance of other specific medical examinations. Our principal conclusion was that these data indicate a need for more education on a variety of issues, including predisposition, healthy behavior, medical care and preventive health utilization issues as they relate to prescribed medication use, and assessment of the long-term effects of drug use on people with intellectual disabilities.

Physical and mental health status of staff working for people with intellectual disabilities in Taiwan: measurement with the 36-Item Short-Form (SF-36) health survey.

Little explicit attention has been given to the generic health profile of staff working for people with intellectual disability in institutions. This study aimed to provide a profile of physical and mental health of staff working in disability welfare institutions, and to examine the possible demographic and organizational factors that explain an association with their health. A cross-sectional questionnaire survey was conducted to analyze 1243 staff (76% response rate) working in 24 institutions in Taiwan. The 36-Item Short-Form (SF-36) Taiwan version was used to measure their generic health status. The mean of Physical component scores (PCS) was slightly higher than Mental component scores (MCS) (50.83 vs. 45.12). With regard to each dimension among PCS, the mean score of Physical functioning (PF) was 57.14 (S.D.=5.93), Role limitations-physical (RP) was 49.88 (S.D.=9.69), Bodily pain (BP) was 52.14 (S.D.=8.09) and General medical health (GH) was 51.50 (S.D.=8.28). Among the MCS, Vitality (VT) was 46.19 (S.D.=6.71); Social functioning (SF) was 46.44 (S.D.=7.58); Role limitations-emotional (RE) was 47.30 (S.D.=11.89) and Mental health (MH) was 43.58 (S.D.=8.81). We found the generic health of staff working for people with intellectual disabilities were significantly lower in PCS and MCS than the Taiwan general population. Influences of staff's demographic and organizational characteristics on their health were also analyzed in the content. This study highlights the authorities and service providers need to continue to develop their awareness and understanding of the experiences that their staff encounters in the organizations, so that they can receive resources to support their positive health in working for people with intellectual disabilities.

Received, understanding and satisfaction of National Health Insurance premium subsidy scheme by families of children with disabilities: a census study in Taipei City.

The purposes of the present study are to provide the first data on utilization, understanding and satisfaction of the National Health Insurance (NHI) premium subsidy for families of children with disabilities in Taipei. Data from the 2001 Taipei Early Intervention Utilization and Evaluation Survey for Aged 0-6 Children with Disabilities were analyzed. In the study, a total of 1006 questionnaires were mailed, of which 340 valid questionnaires were returned, giving a response rate of 33.8%. More than one-third of families of children with disabilities did not receive any financial subsidy of National Health Insurance (NHI). Less than half of the respondents (43.8%) understood the NHI premium subsidy policy completely, while 28.7% partial understood and 27.5% still did not know this auxiliary policy. Approximately 38.5% of the respondents were specifically very satisfied or satisfied, with the NHI subsidy program. There were 18.9% respondents who felt dissatisfied or very dissatisfied with the NHI scheme for children with disabilities in Taiwan. Chi-square or t-test analyses were significant for the caregiver's age (p<0.05), children's disability onset and disability diagnosed age and disability level (p<0.01) on receiving the subsidy assistance. A multiple stepwise logistic regression revealed that the factor of 'onset age of disability' was slightly significant associated with the use of NHI premium subsidy (OR=0.966; 95% CI=0.947-0.986). Health policies should aim to reduce the inequity in NHI premium subsidy utilization and improve their understanding and satisfaction toward this subsidy scheme.

Changes in drug prescription utilization for diabetic and hypertensive outpatients after initiation of the National Health Insurance's Global Budget Program in Taiwan.

BACKGROUND: To examine changes in medicine utilization and prescription trends for diabetic (DM) and hypertensive (HT) patients upon initiation of the National Health Insurance (NHI) global budget (GB) program in Taiwan. MATERIAL/METHODS: Data on hospital-based outpatient prescriptions for DM and HT from the Taipei branch before and after the GB were analyzed from January 2002 to December 2004. A secondary analysis of reimbursed data, with descriptive and trend analyses of the four indicators, daily oral medication cost, daily tablets used, medicine items per prescription, and tablet cost, was conducted. RESULTS: The comparisons of before and after the GB were as follows: Daily oral medication cost increased from US $0.585 to $0.956 (64%) for the DM group and from $1.01 to $1.07 (6.12%) for the HT group. The increments for daily used tablets, medicine items per prescription, and tablet cost were 33.3%, 17.9%, and 26.5% for the DM group and 6.65%, 3.31%, and 0.27% for the HT group. Indicators for the DM group not only increased significantly compared with those of the HT group, but also had higher adjusted beta coefficients. The comparisons of before and after the GB showed that the increments for the DM group decreased slightly, but not those for the HT group. CONCLUSIONS: The indicators for DM were significantly higher than those of HT group during the implementation phase of the GB. The GB program implemented by the NHI in Taiwan slightly slowed the trend of hospital-based ambulatory prescription costs of DM, but not HT.

Assessment of GPs' beliefs relating to the care of people with intellectual disabilities: a Taiwan-based, opportunity-guided approach.

PURPOSE: This study was designed to investigate general practitioners' (GPs) beliefs about the perceived importance of their role in, and their satisfaction with, providing healthcare to people with intellectual disabilities. The identification of healthcare issues with potential for improvement was assessed using gap analysis and an opportunity-guided method. METHOD: A cross-sectional census survey by a mail-structured questionnaire recruited 331 GPs (response rate--16%) who provided information on healthcare for people with intellectual disabilities in 2006 in Taiwan. RESULTS: The results indicated that GPs considered their role in providing healthcare for people with intellectual disabilities to be important (mean score 7.2-8.3). However, the respondents generally did not feel satisfied (mean score 4.6-5.5) with their achievements in treating patients with intellectual disabilities. We found that the gender and educational level of the respondents were statistically correlated to the perceived importance they considered their work to have, while the factors of age, medical practice setting and training experience in intellectual disability were statistically correlated to GPs' perceived satisfaction in providing healthcare to people with intellectual disabilities (p < 0.05). Those healthcare issues of'training and experience in intellectual disability', 'multi-disciplinary and multi-sectoral cooperation', 'adequate competence in disability diagnosis', 'genetic consulting services', 'duty of disease prevention and health promotion', and 'adequate medical consultation time' were the five most promising areas to be improved in healthcare for people with intellectual disabilities according to the opportunity-guided analysis. CONCLUSIONS: This study highlights that health professionals need to examine carefully healthcare issues pertaining to people with ID, and that much more effort is required to develop appropriate healthcare policies based on the opportunity-guided health issues identified here.

Cost benefits of targeting the pneumococcal vaccination program to the elderly population in Taiwan.

BACKGROUND: Because of the continuing rise in pneumococcal vaccine costs and limits on funding of such costs, vaccination priorities in Taiwan were assessed. METHODS: Data of a randomly selected sample of 200,448 people were analyzed to identify the highest risk groups. Patients were subgrouped on the basis of age and gender, and estimates were made of cumulative admissions, pneumonia recurrence rate, and associated costs of hospital care and medical treatment over the period 1997-2002 for each subgroup. RESULTS: The per capita costs of medical treatment for pneumonia in those aged 65 years or above were found to be highest in those with chronic lung disease (19,906,086 US dollars), heart disease (19,692,769 US dollars), and diabetes mellitus (8,613,973 US dollars). CONCLUSION: Elderly adults over age 65 years with these chronic diseases should be considered high-priority candidates for pneumococcal vaccination.

A cross-sectional study of the characteristics and determinants of emergency care utilization among people with intellectual disabilities in Taiwan.

AIMS: The purpose of this study was to identify health characteristics of people with intellectual disabilities (ID) and to assess the use of emergency care facilities by these people and factors affecting this utilization. METHOD: A cross-sectional study was employed. Subjects were recruited from the Taiwan National Disability Registration System. A total of 1071 people registered with ID in Taiwan were recruited for this study in 2001. Data were collected via a structured mail-out questionnaire that was completed by the main carers of people with ID. RESULTS: Most of the carers subjectively characterized the overall health status of people with ID as good-excellent. However, people with ID carry a burden of diseases greater than that of the general population. Nearly half (47.7%) of the subjects reported having an illness in the past 7 months. Most of the morbidity was associated with neurological, psychiatric, digestive, dermatological and cardiovascular diseases or disorders. One-third of subjects took medication regularly and 15% were 'Major Illness' card beneficiaries of the Taiwan National Health Insurance scheme. About two-thirds of individuals with ID were classified as having multiple disabilities and 24.5% needed to be provided with frequent rehabilitative therapies to maintain their normal daily functions. Respondents indicated that 18.4% of the subjects had used emergency care in the past 7 months. A stepwise logistic regression model highlighted that the following need factors were significantly related to the utilization of emergency care: having an illness (OR=2.1, 95% CI=1.2-3.6), taking medicine regularly (OR=1.8, 95% CI=1.1-2.9) and self-reported health status (poor health: OR=9.9, 95% CI=2.1-45.7; bad health: OR=8.2, 95% CI=1.3-49.8). CONCLUSIONS: To ensure that people with ID minimize their utilization of emergency care, it is necessary to establish in appropriate community systems to monitor individuals with ID with poor health status, diseases and who take medicine regularly.