Shackley P, Donald S
Health Economics Research Unit, University of Aberdeen, UK.
Health Policy. 1993 Sep;25(1-2):51-62. doi: 10.1016/0168-8510(93)90102-u.
The recent reforms of the NHS have clearly emphasised the potential role of prevention in reducing mortality and morbidity. The specific focus of this paper is the preventive aspects of the new GP contract, and in particular the contractual obligation on GPs to offer an annual assessment to all patients within their practice aged 75 years and over. In reviewing the literature for evidence pertaining to the assessment of elderly people, it is argued that there are a number of unresolved issues which raise certain question marks over the Government's decision to include such assessments in the GP contract. The most fundamental of these issues is whether the costs of such screening are justified by the associated benefits. Other issues relate to the organisation of the assessments. In an attempt to cast some light on these unresolved issues, the results from a recent national survey of GPs in Scotland are presented. The results do not allow a categorical statement to be made on whether or not the assessments are worthwhile per se. However, they do help to clarify the current state of screening elderly people in general practice. In the light of this, directions for future research into the screening of elderly people are suggested.
英国国家医疗服务体系（NHS）近期的改革明确强调了预防在降低死亡率和发病率方面的潜在作用。本文的具体关注点是新的全科医生合同中的预防方面，特别是全科医生有合同义务为其执业范围内所有75岁及以上的患者提供年度评估。在回顾有关老年人评估的文献时，有人认为存在一些未解决的问题，这对政府将此类评估纳入全科医生合同的决定提出了某些疑问。其中最根本的问题是，这种筛查的成本是否能由相关益处来证明其合理性。其他问题涉及评估的组织安排。为了对这些未解决的问题有所了解，本文呈现了最近在苏格兰对全科医生进行的全国性调查结果。这些结果无法就评估本身是否值得做出明确的陈述。然而，它们确实有助于阐明在全科医疗中筛查老年人的现状。有鉴于此，本文提出了未来老年人筛查研究的方向。
