Journal Article

Physical restraint to patients with dementia in acute physical care settings: effect of the financial incentive to acute care hospitals

Okumura, Yasuyuki, Ogawa, Asao, Nakanishi, Miharu

2018

Overview

ABSTRACTBackgroundIn April 2016, the Japanese government introduced an additional benefit for dementia care in acute care hospitals (dementia care benefit) into the universal benefit schedule of public healthcare insurance program. The benefit includes a financial disincentive to use physical restraint. The present study investigated the association between the dementia care benefit and the use of physical restraint among inpatients with dementia in general acute care settings. MethodsA national cross-sectional study design was used. Eight types of care units from acute care hospitals under the public healthcare insurance program were invited to participate in this study. A total of 23,539 inpatients with dementia from 2,355 care units in 937 hospitals were included for the analysis. Dementia diagnosis or symptoms included any signs of cognitive impairment. The primary outcome measure was “use of physical restraint.” ResultsAmong patients, the point prevalence of physical restraint was 44.5% ( n = 10,480). Controlling for patient, unit, and hospital characteristics, patients in units with dementia care benefit had significantly lower percentage of physical restraint than those in any other units (42.0% vs. 47.1%; adjusted odds ratio, 0.76; 95% confident interval [0.63, 0.92]). ConclusionsThe financial incentive may have reduced the risk of physical restraint among patients with dementia in acute care hospitals. However, use of physical restraint was still common among patients with dementia in units with the dementia care benefit. An educational package to guide dementia care approach including the avoidance of physical restraint by healthcare professionals in acute care hospitals is recommended.

• Publisher: Cambridge University Press,Elsevier Inc
• Subject: acute care hospital / Acute services / Aged / Alzheimer's disease / Approach-Avoidance / Cognition / Cognitive ability / Cognitive impairment / Consent / Critical Care - methods / Cross-sectional studies / Cross-Sectional Studies - classification / Dementia / Dementia - epidemiology / Dementia - physiopathology / Dementia - therapy / Design / Female / Health care / Health insurance / Health services / Hospitals / Humans / Incentives / Inpatient care / Intensive Care Units - statistics & numerical data / Japan - epidemiology / Long term health care / Male / Medical diagnosis / Medical personnel / Mental disorders / Mental health care / Monetary incentives / Original Research Article / Patients / Physical disabilities / physical restraint / Physical restraints / Public finance / Questionnaires / R&D / Research & development / Restraint, Physical - adverse effects / Restraint, Physical - methods / Restraint, Physical - psychology / Risk Assessment / Studies