Objective To explore predictors of district nursing care
utilisation for community-living
(older) people in the
Netherlands using claims data. To cope with growing
demands in district nursing care, knowledge about the
current utilisation of district nursing care is important.
Setting District nursing care as a part of primary care.
Participants In this nationwide study, claims data were
used from the Dutch risk adjustment system and national
information system of health insurers. Samples were
drawn of 5500 pairs of community-living
people using
district nursing care (cases) and people not using district
nursing care (controls) for two groups: all ages and aged
75+ years (total N=22 000).
Outcome measures The outcome was district nursing
care utilisation and the 114 potential predictors included
predisposing factors (eg, age), enabling factors (eg,
socioeconomic status) and need factors (various
healthcare costs). The random forest algorithm was used
to predict district nursing care utilisation. The performance
of the models and importance of predictors were
calculated.
Results For the population of people aged 75+ years,
most important predictors were older age, and high
costs for general practitioner consultations, aid devices,
pharmaceutical care, ambulance transportation and
occupational therapy. For the total population, older age,
and high costs for pharmaceutical care and aid devices
were the most important predictors.
Conclusions People in need of district nursing care are
older, visit the general practitioner more often, and use
more and/or expensive medications and aid devices.
Therefore, close collaboration between the district nurse,
general practitioner and the community pharmacist is
important. Additional analyses including data regarding
health status are recommended. Further research is
needed to provide an evidence base for district nursing
care to optimise the care for those with high care needs,
and guide practice and policymakers’ decision-making.
