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. 2024 Dec;39(16):3146-3154.
doi: 10.1007/s11606-024-09003-2. Epub 2024 Sep 4.

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

Masashi Shibata  1   2 , Takuya Aoki  3   4 , Masato Matsushima  3
Affiliations

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

Masashi Shibata et al. J Gen Intern Med. 2024 Dec.

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.

Keywords: COVID-19; emergency house call; end-of-life care; home healthcare services.

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Conflict of interest statement

Declarations:. 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.

Figures

Figure 1
Figure 1
Changes in the monthly uses of regular home visits and emergency house calls before and during the COVID-19 pandemic in Japan. From April 2019 to March 2022, the monthly uses of regular home visits (A) and emergency house calls (B) are depicted. The points represent the total monthly uses observed, the solid line illustrates the forecast trend based on the model, and the dashed line indicates the predicted trend in a counterfactual scenario without the COVID-19 pandemic. The gray squares highlight the period following the onset of the COVID-19 pandemic.
Figure 2
Figure 2
Changes in the monthly uses of terminal care and in-home deaths before and during the COVID-19 pandemic in Japan. From April 2019 to March 2022, the monthly uses of terminal care (A) and in-home deaths (B) are presented. The points represent the total monthly uses observed, the solid line illustrates the forecast trend based on the model, and the dashed line indicates the predicted trend in a counterfactual scenario without the COVID-19 pandemic. The gray squares highlight the period following the onset of the COVID-19 pandemic.
Figure 3
Figure 3
Changes in the monthly uses of terminal care stratified by care setting and type of home medical care facilities before and during the COVID-19 pandemic in Japan. From April 2019 to March 2022, the monthly uses of terminal care, stratified by care setting (A) and type of home medical care facilities (B), are illustrated. Care settings include home (magenta) and nursing home (green), while facility types are represented by enhanced HCSCs (magenta), HCSCs (blue), and general clinics and hospitals (green). The points represent the total monthly uses observed, the solid line illustrates the forecast trend based on the model, and the dashed line indicates the predicted trend in a counterfactual scenario without the COVID-19 pandemic. The gray squares highlight the period following the onset of the COVID-19 pandemic.
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References

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