Longitudinal Outcomes of Home Care in Korea to Manage Pressure Ulcers

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Pressure ulcers (PrUs) are localized injuries to the skin caused by pressure or shear, and they result in significant health problems such as pain, disfigurement, and functional impairment (National Pressure Ulcer Advisory Panel, 2014). PrUs afflict not only patients in hospitals but also those in nursing homes, those receiving home care, and those living in community settings (Gunningberg, Hommel, Baath, & Idvall, 2013; Woo et al., 2017). People with deep PrUs need immediate treatment because deterioration of PrUs due to lack of proper treatment may lead to infection (Khor et al., 2014), and deep PrUs increase the risk of death (Brown, 2003; Khor et al., 2014). Thus, PrUs have a significant impact on health‐related quality of life and cause substantial economic burden to patients (Demarre et al., 2015; Vu, Harris, Duncan, & Sussman, 2007). The burden of treatment may be much higher in economically vulnerable individuals with PrUs who do not receive proper medical care due to economic problems, as compared to other groups. Moreover, because PrU care requires high‐level skills, caregivers also face heavy burdens in caring for patients who have PrUs (Rodriques, Ferreira, & Ferre‐Grau, 2016).
In South Korea, the compulsory National Health Insurance (NHI) system covers approximately 97% of the total population, and the remainder who are below the poverty line are covered by the Medical‐Aid Program (MAP; Song, 2009). NHI and MAP cover healthcare services provided by clinics, hospitals, and home care including hospitalization, outpatient care, and rehabilitation. Despite the broad extent of NHI and MAP coverage in the South Korean population, out‐of‐pocket payments (OOPs) are high because of non‐covered services and co‐payments for covered services; the recent OOP was $5.60 per outpatient visit and $157.10 per inpatient day (Lee & Shaw, 2014). As a result, economically vulnerable populations (less than 50% of the median income) have financial barriers to adequate health care. For these populations, public healthcare centers (PHCs) in South Korea provide essential care services. However, PrUs require a more intensive level of care (Kwon, Lim, Lee & Kim, 2010); in these cases, the nurses request assistance from facilities such as hospitals, nursing homes, and home care agencies. Most economically vulnerable individuals with health problems cannot be hospitalized because they are unable to afford the high OOPs for inpatient care. Instead, they receive healthcare from a community‐based home care agency.
The home care agency in South Korea employs advanced practice nurses (APNs) who are educated at the graduate level and certified for advanced practice in home care settings. Their assessment, diagnostic, and coordination skills enable high‐quality service and complete health care management for patients. They provide care for patients who are discharged early from the hospital, which is called hospital‐based home care and is covered by NHI. They also provide home care for vulnerable populations in the community, which is called community‐based home care and is covered by taxes or long‐term care insurance. The APNs provide essential care for ill individuals who are economically or socially marginalized.
In most studies, the incidence and prevalence of PrU in home care setting was lower than in hospitals or nursing homes (Bergquist & Gajewski, 2011; Gunningberg et al., 2013; Yamamoto‐Mitani et al., 2011); however, treating PrUs after they develop is more difficult at home than other settings due to limited resources (Chaves, Grypdonck, & Defloor, 2006; Meaume & Marty, 2015). Nevertheless, home care services have shown strong performance in prevention and management of PrUs (Bergquist, 2003; Sankaran et al., 2015).
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