Development of the Houston-Apollo Model for the Older People Living in Remote Areas in Taiwan

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background: </jats:bold>Senior healthcare is challenging in remote areas, especially in an economically disadvantaged population with a high portion of elderly constituents. Guided by Andersen’s Behavior Model, this study examined whether a combined health care system (Houston-Apollo Model, HAM) will improve physical performance and foster medical care utilization of the local population. <jats:bold>Methods: </jats:bold>People aged ≥ 65 years who participated in congregate meal services (CMS) were recruited. Using concepts of telemedicine and community health records, participants received consultation from local clinics, which provided advices or arranged referral to National Taiwan University Hospital Yunlin Branch (NTUHYL). Physical parameters including blood pressure, body mass index, grip strength, walking speed, and five-time sit and stand test (FTSST) were recorded and timely transferred to NTUHYL, which in turn result in individualization of intervention strategies. Changes in physical parameters and utilization of healthcare facilities were measured in the beginning of recruitment and one year later to evaluate the effectiveness of the plan.<jats:bold>Results: </jats:bold>470 people were recruited. In 1-year follow-up, the mean systolic and diastolic blood pressure (mmHg) decreased from 137.4 to 133.3 (p = 0.019) and from 76.9 to 74.4 (p = 0.008), respectively. The mean time of FTSST (seconds) decreased from 11.3 to 10.4 (p = 0.011). The mean walking speed (m/s) increased from 0.71 to 0.74 (p = 0.039). The rate ratio (95%CI) of medical and dental outpatient clinic usage were 2 (1.1-3.64) and 1.14 (1.06-1.23), respectively. <jats:bold>Conclusions: </jats:bold>The HAM health care system could benefit the physical status of older adults, promote proactive and preventive health care utilization, and contribute to medical equality.</jats:p>