Spatial accessibility of home visiting nursing: An exploratory ecological study

Abstract

Background and AimsJapan is one of the oldest societies worldwide and manages a system of care for older adults in the community. In the 2000s, a community‐based integrated care system was introduced to enable older adults to live in their neighborhoods. Home visiting nursing (HVN) is a crucial component of this system; however, the current and future shortage of home visiting nurses is a concern. Thus, HVN services may not be available in some areas; however, no indicators of the accessibility of HVN services have been developed. Developing accessibility indicators will serve as a standard for considering the allocation of health care resources and supporting future nursing policies that improve regional disparities.MethodsWe estimated the population‐weighted spatial accessibility index (PWSAI) of HVN services in Hokkaido, using the two‐step floating catchment area method (2SFCA). The 2SFCA comprised population, location of HVN agencies, number of home visiting nurses, and travel time. A multivariate regression model was run for the number of HVN users in each municipality as the objective variable to test the validity of the PWSAI; the number of home care support clinics, home care support hospitals, HVN agencies, home visiting nurses, home visiting nurses (24/7), total beds in health care facilities for older adults, and nursing homes for older adults were included as other explanatory variables.ResultsThe PWSAI was median 9.0 [interquartile range: 6.2−11.8]. The distribution of the PWSAI was mapped to visualize the existence of regional differences. As a result of the conditional autoregressive model, PWSAI and home visiting nurses (24/7) were significant, Exp(β) and 95% credible interval were 1.043 [1.015−1.076] and 1.021 [1.006−1.036], respectively.ConclusionThe PWSAI was positively correlated with the number of HVN users in each municipality and can serve as an indicator for assessing the accessibility of HVN.