Urban-rural differences in hospitalisation rates among elderly patients in two long-term care settings in Tuscany, Italy

Context Patients who are in nursing homes or homes in community-based settings that belongs to the category of elderly in long-term care (LTC) often have complex needs that require different kinds of support because of their functional and cognitive limitations, as well as their need for medical care for acute and chronic conditions. Our aim was to see if there are any differences between hospitalizations in high and low density areas for the patients who are in an LTC program, in nursing homes or in home care. Methods This study is an ecological study using data sources from the Tuscany region during the period 2012-2013. In our study we measured the percentage of hospitalization. We measured the use of hospitalization by the dependent elderly in home care and nursing homes, taking into account that they have complex needs. Our analysis has drawn on administrative health data for those aged 65 and over with complex needs who are in an individual planning program in Tuscany, Italy. Hospital discharge data were obtained from the Agenzia regionale di sanita della Toscana (ARS).The denominator was the elderly in home care and residential care, during the given period (1000 personyears). Levels of rurality were measured using OECD REGIONAL TYPOLOGY, 2010, which is based on the criteria of population density and size of the urban centres located within a region. Descriptive and inferential statistics were performed. Results Our sample size was 13,869 patients in the Tuscany region who were in the LTC program during the period 20122013. The median rate of hospitalization in low density areas was 49.33% (per 100 person-years) for the elderly in home care, and 51.08% (per 100 person-years) from more densely populated districts. For elderly people in residential care, the median rate of hospitalization was 42.48% (per 100 person-years) in low density areas and 47.36% (per 100 person-years) in high density districts. The p-values for low vs high density areas are 0.120 for the first indicator, and 0.358 for the second indicator. Discussion Our findings show that there are not significant differences of health disparities between elderly in Long term care program in rural and urban areas, which may derive from free access to care and more healthcare programs in rural areas. Although certain disparities still exit, like a higher hospitalization rate in more densely population districts, especially in home care, the health care system has effectively reduced rural-urban disparities when it comes to the elderly with complex needs. Further steps are needed to be performed in order to delve this preliminary evidence.