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Impact of the COVID-19 Pandemic on Home Medical Care Utilization in Japan: An Interrupted Time Series Analysis

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Abstract

Background

The COVID-19 pandemic affected healthcare utilization worldwide, but changes in home medical care utilization have not been fully revealed.

Objective

This study aims to clarify the changes in the use of home medical care services in Japan due to the pandemic.

Design

Interrupted time series analysis of national medical claims data.

Participants

Individuals with home medical care use occurring in Japan between April 2019 and March 2022.

Interventions

The declaration of a state of emergency (April 2020) by the Japanese government.

Main Measures

The outcomes were the monthly uses of regular home visits, emergency house calls, terminal care, and in-home deaths. Terminal care was stratified by care setting (home or nursing home) and the type of home medical care facilities (enhanced home care support clinics and hospitals (HCSCs), conventional HCSCs, and general clinics and hospitals).

Key Results

Regular home visits showed no significant change, but emergency house calls exhibited an upward trend (1258 uses/month, 95% CI 43 to 2473). Both terminal care and in-home deaths experienced an immediate increase in level (1116 uses/month, 95% CI 549 to 1683; 1459 uses/month, 95% CI 612 to 2307), followed by a gradual increase in trend (141 uses/month, 95% CI 73 to 209; 215 uses/month, 95% CI 114 to 317). The immediate increase of terminal care occurred only for home patients. Enhanced HCSCs showed the most prominent increase in both level and trend, followed by conventional HCSCs, and general clinics and hospitals.

Conclusions

The COVID-19 pandemic increased the use of emergency house calls and terminal care among home medical care in Japan, particularly for home patients and enhanced HCSCs. These findings suggest that the pandemic revitalized the importance of home medical care as a patient-centered care delivery model and highlight the need for strategic healthcare planning and home medical care resource allocation to anticipate future pandemics.

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Data Availability

The minimal dataset necessary to replicate our study findings can be accessed directly through the Ministry of Health, Labour and Welfare's website (https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000177182.html). This link leads to the NDB Open Data Japan which contains the data we have utilized.

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Acknowledgements:

The authors are grateful to the lecturers and trainees of Jikei Clinical Research Program for Primary-care for their insightful suggestions. We also thank OpenAI’s ChatGPT4 (https://chat.openai.com/) for proofreading our manuscript.

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Authors and Affiliations

  1. Department of General Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan

    Masashi Shibata MD

  2. Department of General Medicine, Kaita Hospital, Fukuoka, Japan

    Masashi Shibata MD

  3. Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan

    Takuya Aoki MD, PhD, MMA & Masato Matsushima MD, PhD, MPH

  4. Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Takuya Aoki MD, PhD, MMA

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  1. Masashi Shibata MD
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Correspondence to Masashi Shibata MD.

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Conflict of Interest:

Dr. Shibata is a trainee of Jikei Clinical Research Program for Primary-care. Dr. Aoki is a lecturer of Jikei Clinical Research Program for Primary-care. Dr. Matsushima is the program director and a lecturer of Jikei Clinical Research Program for Primary-care. Drs. Aoki and Matsushima received lecture fees and lecture travel fees from the Centre for Family Medicine Development of the Japanese Health and Welfare Co-operative Federation. Drs. Aoki and Matsushima are advisers of the Centre for Family Medicine Development practice-based research network. Dr. Matsushima’s son-in-law worked at IQVIA Services Japan K.K. which is a contract research organization and a contract sales organization. Dr. Matsushima’s son-in-law works at SYNEOS HEALTH CLINICAL K.K. which is a contract research organization and a contract sales organization.

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Shibata, M., Aoki, T. & Matsushima, M. Impact of the COVID-19 Pandemic on Home Medical Care Utilization in Japan: An Interrupted Time Series Analysis. J GEN INTERN MED (2024). https://doi.org/10.1007/s11606-024-09003-2

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