Wasson J H, Stukel T A, Weiss J E, Hays R D, Jette A M, Nelson E C
Center for the Aging, Dartmouth Medical School, Hanover, NH, USA.
Eff Clin Pract. 1999 Jan-Feb;2(1):1-10.
Because of time constraints in the office environment, problems of concern to elderly patients may not be raised during clinic visits. To facilitate communication about geriatric health problems, we examined the impact of a strategy that used patient self-assessment data to improve community practices.
Twenty-two primary care practices were randomized to participate in the intervention strategy (intervention practices) or to provide usual care (usual care practices).
Primary care practices in 16 towns in New Hampshire (total, 45 physicians).
1651 patients 70 years of age or older.
All patients received a mailed survey that asked about their health problems and about how well these problems were being addressed by their physicians. In the intervention practices, these data were used to generate a customized letter that directed the patient to specific sections in an 80-page modified version of the National Institute on Aging's Age Pages and were summarized and communicated to the patient's physician.
Change from baseline in patients' overall assessment of health care.
In 8 of 11 intervention practices, patients felt that their care had improved over the 2-year study period. This improvement occurred in only 1 of 11 usual care practices (P = 0.003). Patients in intervention practices reported receiving significantly more help with physical function, fall prevention, and assistance for memory problems. Self-assessed health status did not differ in the two groups.
A standard, easy-to-implement strategy to improve the quality of provider--patient interactions can improve the satisfaction of older patients cared for in community practices.
由于办公室环境存在时间限制，老年患者关心的问题在门诊就诊时可能未被提出。为促进关于老年健康问题的沟通，我们研究了一种利用患者自我评估数据来改善社区医疗实践的策略的影响。
22家初级保健机构被随机分为参与干预策略组（干预机构）或提供常规护理组（常规护理机构）。
新罕布什尔州16个城镇的初级保健机构（共45名医生）。
1651名70岁及以上的患者。
所有患者都收到一份邮寄的调查问卷，询问他们的健康问题以及医生对这些问题的处理情况。在干预机构中，这些数据被用于生成一封定制信件，引导患者查阅美国国立衰老研究所《老年专页》80页修订版中的特定章节，并进行总结后传达给患者的医生。
患者对医疗保健总体评估相对于基线的变化。
在11家干预机构中的8家，患者感觉在为期2年的研究期间他们得到的护理有所改善。这种改善仅在11家常规护理机构中的1家出现（P = 0.003）。干预机构的患者报告在身体功能、预防跌倒和记忆问题协助方面得到了显著更多的帮助。两组患者自我评估的健康状况没有差异。
一种标准的、易于实施的改善医患互动质量的策略可以提高社区医疗中老年患者的满意度。
