title: Factors associated with the use of home-visit nursing services covered by the long-term care insurance in rural Japan: a cross-sectional study.
abstract: BACKGROUND
  In Japan, there is a large increase in the number of elderly persons who potentially need home-visit nursing services (VNS). However, the number of persons using the VNS has increased only little in comparison to the number of individuals who use home social services, which are also covered by the Long-Term Care Insurance (LTCI) system. This cross-sectional study investigated the predictors of the VNS used under the LTCI system in Japan.
  
  
  METHODS
  We used 1,580 claim data from all the users of community-based services and 1,574 interview survey data collected in 2001 from the six municipal bodies in Japan. After we merged the two datasets, 1,276 users of community-based services under the LTCI were analyzed. Multiple logistic regression models stratified by care needs levels were used for analysis.
  
  
  RESULTS
  Only 8.3% of the study subjects were VNS users. Even among study participants within the higher care-needs level, only 22.0% were VNS users. In the lower care level group, people with a higher care level (OR: 3.50, 95% CI: 1.50-8.93), those whose condition needed long term care due to respiratory or heart disease (OR: 4.31, 95% CI: 1.88-89.20), those whose period of needing care was two years or more (OR: 2.01, 95% CI: 1.14-3.48), those whose service plan was created by a medical care management agency (OR: 2.39, 95% CI: 1.31-4.33), those living with family (OR: 1.86, 95% CI: 1.00-3.42), and those who use home-help services (OR: 2.12, 95% CI: 1.17-3.83) were more likely to use the VNS. In the higher care level group, individuals with higher care level (OR: 3.63, 95% CI: 1.56-8.66), those with higher income (OR: 3.79, 95% CI: 1.01-14.25), and those who had regular hospital visits before entering the LTCI (OR: 2.36, 95% CI: 1.11-5.38) were more likely to use the VNS.
  
  
  CONCLUSIONS
  Our results suggested that VNS use is limited due to management by non-medical care management agencies, due to no caregivers being around or a low income household. The findings of this study provide valuable insight for LTCI policy makers: the present provision of VNS should be reconsidered.
authors.affiliation: Department of Health Services Research, faculty of medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba Ibaraki, 305-8575, Japan.
authors.forename: Masayo
authors.initials: M
authors.lastname: Kashiwagi
authors.forename: Nanako
authors.initials: N
authors.lastname: Tamiya
authors.forename: Mikiya
authors.initials: M
authors.lastname: Sato
authors.forename: Eiji
authors.initials: E
authors.lastname: Yano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D016208:Databases, Factual / Q000639:trends; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data* / Q000639:trends; D006792:House Calls / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007353:Insurance, Long-Term Care / Q000706:statistics & numerical data* / Q000639:trends; D007355:Insurance, Nursing Services / Q000706:statistics & numerical data* / Q000639:trends; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012424:Rural Population / Q000639:trends