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      Use of professional home care in persons with spinal cord injury in Switzerland: a cross-sectional study

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          Abstract

          Background

          Persons with spinal cord injury (SCI) living in the community often require care. The boundaries between professional home care and informal care are blurred, and it is unclear who the typical user of home care is. The objective of this study was to describe the characteristics of persons with SCI using professional home care in Switzerland, determine the frequency of home care visits, and investigate the association of sociodemographic factors, SCI-specific characteristics, secondary health conditions, and functional independence with the use of home care.

          Methods

          We used cross-sectional data from the 2017 community survey of the Swiss Spinal Cord Injury Cohort Study (SwiSCI). Out of 3,959 eligible individuals 1294 completed the questionnaire and were included in the analysis (response rate 33%). Using descriptive statistics, differences between home care users and non-users as well as the frequency of home care visits were investigated. The association between sociodemographic factors, SCI-specific characteristics, secondary health conditions, functional independence and the use of home care was analyzed using multivariable logistic regression. Multiple imputation was used to account for missing data.

          Results

          Of 1,294 participants, 280 (22%) used professional home care. The median weekly professional home care duration was 6 h (Q1 = 2, Q3 = 12). More home care was used in persons with lower functional independence (Odds ratio (OR) 0.30 per 10 unit decrease in the Spinal Cord Independence Measure, 95%-Confidence interval (CI) 0.24–0.37), fewer secondary health conditions (OR 0.96 per unit Spinal Cord Injury Secondary Conditions Scale, 95%-CI 0.94–0.99), tetraplegia (OR 2.77, 95%-CI 1.92–4.00), women (OR 2.42, 95%-CI 1.70–3.43), higher age (OR 1.22 per 10 years increase, 95%-CI 1.06–1.39), living alone (OR 2.48, 95%-CI 1.53–4.03), and those receiving support from an informal caregiver (OR 1.88, 95%-CI 1.27–2.77).

          Conclusions

          This is the first study to examine the use of professional home care from the perspective of persons with SCI in Switzerland. Lower functional independence strongly predicts increased home care use. The findings showed that professional home care complements informal care and is more likely to be used by individuals with SCI who live alone, have tetraplegia, and are female.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12913-023-10429-3.

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          Purposeful selection of variables in logistic regression

          Zoran Bursac, C Gauss, David Williams … (2008)
          Background The main problem in many model-building situations is to choose from a large set of covariates those that should be included in the "best" model. A decision to keep a variable in the model might be based on the clinical or statistical significance. There are several variable selection algorithms in existence. Those methods are mechanical and as such carry some limitations. Hosmer and Lemeshow describe a purposeful selection of covariates within which an analyst makes a variable selection decision at each step of the modeling process. Methods In this paper we introduce an algorithm which automates that process. We conduct a simulation study to compare the performance of this algorithm with three well documented variable selection procedures in SAS PROC LOGISTIC: FORWARD, BACKWARD, and STEPWISE. Results We show that the advantage of this approach is when the analyst is interested in risk factor modeling and not just prediction. In addition to significant covariates, this variable selection procedure has the capability of retaining important confounding variables, resulting potentially in a slightly richer model. Application of the macro is further illustrated with the Hosmer and Lemeshow Worchester Heart Attack Study (WHAS) data. Conclusion If an analyst is in need of an algorithm that will help guide the retention of significant covariates as well as confounding ones they should consider this macro as an alternative tool.
          Article 0 comments Cited 720 times – based on 0 reviews     Review now
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            Does informal care from children to their elderly parents substitute for formal care in Europe?

            Eric Bonsang (2008)
            This paper analyzes the impact of informal care by adult children on the use of long-term care among the elderly in Europe and the effect of the level of the parent's disability on this relationship. We focus on two types of formal home care that are the most likely to interact with informal care: paid domestic help and nursing care. Using recent European data emerging from the Survey on Health, Ageing and Retirement in Europe (SHARE), we build a two-part utilization model analyzing both the decision to use each type of formal care or not and the amount of formal care received by the elderly. Instrumental variables estimations are used to control for the potential endogeneity existing between formal and informal care. We find endogeneity of informal care in the decision to receive paid domestic help. Estimation results indicate that informal care substitutes for this type of formal home care. However, we find that this substitution effect tends to disappear as the level of disability of the elderly person increases. Finally, informal care is a weak complement to nursing care, independently of the level of disability. These results highlight the heterogeneous effects of informal care on formal care use and suggest that informal care is an effective substitute for long-term care as long as the needs of the elderly are low and require unskilled type of care. Any policy encouraging informal care to decrease long-term care expenditures should take it into account to assess its effectiveness.
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              Informal and formal care among single-living elderly in Europe.

              B. Staffan Lindgren, K Bolin, P Lundborg (2008)
              The aims of this study were to analyse (1) whether informal care, provided by children or grandchildren to their elderly parents, and formal care are substitutes or complements, and (2) whether this relationship differs across Europe. The analyses were based on cross-sectional data from the newly developed SHARE (Survey of Health, Ageing, and Retirement in Europe) database. We found (1) that informal and formal home care are substitutes, while informal care is a complement to doctor and hospital visits, and (2) that these relationships in some cases differ according to a European north-south gradient. Instrumental variable methods were used and the results highlight the importance of accounting for the endogeneity of informal care.
              Article 0 comments Cited 86 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Armin Gemperli: armin.gemperli@unilu.ch
                Journal
                Journal ID (nlm-ta): BMC Health Serv Res
                Journal ID (iso-abbrev): BMC Health Serv Res
                Title: BMC Health Services Research
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1472-6963
                Publication date (Electronic): 12 December 2023
                Publication date PMC-release: 12 December 2023
                Publication date Collection: 2023
                Volume: 23
                Electronic Location Identifier: 1393
                Affiliations
                [1 ]Swiss Paraplegic Research, ( https://ror.org/04jk2jb97) Nottwil, Switzerland
                [2 ]Swiss Paraplegic Centre, ( https://ror.org/01spwt212) Nottwil, Switzerland
                [3 ]Faculty of Health Sciences and Medicine, University of Lucerne, ( https://ror.org/00kgrkn83) Lucerne, Switzerland
                [4 ]ParaHelp AG, Nottwil, Switzerland
                [5 ]REHAB Basel, Klinik für Neurorehabilitation und Paraplegiologie, Basel, Switzerland
                [6 ]Clinique Romande de Réadaptation, ( https://ror.org/05kz5x194) Sion, Switzerland
                [7 ]Balgrist University Hospital, ( https://ror.org/01462r250) Zurich, Switzerland
                [8 ]Center of Primary and Community Care, University of Lucerne, ( https://ror.org/00kgrkn83) Lucerne, Switzerland
                Article
                Publisher ID: 10429
                DOI: 10.1186/s12913-023-10429-3
                PMC ID: 10714621
                PubMed ID: 38087349
                SO-VID: 650ac6bb-b317-4ce7-9256-327cb09cd333
                Copyright © © The Author(s) 2023
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 2 June 2023
                Date accepted : 4 December 2023
                Funding
                Funded by: Swiss Paraplegic Research
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © BioMed Central Ltd., part of Springer Nature 2023

                ScienceOpen disciplines: Health & Social care
                Keywords: home care,spinal cord injury,informal care,cross-sectional survey
                Data availability:
                ScienceOpen disciplines: Health & Social care
                Keywords: home care, spinal cord injury, informal care, cross-sectional survey

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