Pell J, Williams S
Greater Glasgow Health Board.
Br J Gen Pract. 1999 Jul;49(444):527-30.
The number of people residing in nursing homes has increased. General practitioners (GPs) receive an increased capitation fee for elderly patients in recognition of their higher consultation rate. However, there is no distinction between elderly patients residing in nursing homes and those in the community.
To determine whether nursing home residents receive greater general practice input than people residing in the community.
Prospective comparative study of all 345 residents of eight nursing homes in Glasgow and a 2:1 age, sex, and GP matched comparison group residing in the community. A comparison of contacts with primary care over three months in terms of frequency, nature, length, and outcome was carried out.
Nursing home residents received more total contacts with primary care staff (P < 0.0001) and more face-to-face consultations with GPs (P < 0.0001). They were more likely to be seen as an emergency (P < 0.01) but were no more likely to be referred to hospital, and were less likely to be followed-up by their GP (P < 0.0001). Although individual consultations with nursing home residents were shorter than those with the community group (P < 0.0001), the overall time spent consulting with them was longer (P < 0.001). This equated to an additional 28 minutes of time per patient per annum. Some of this time would have been offset by less time spent travelling, since 61% of nursing home consultations were done during the same visit as other consultations, compared with only 3% of community consultations (P < 0.0001).
Our study suggests that nursing home residents do require a greater input from general practice than people of the same age and sex who are residing in the community. While consideration may be given to greater financial reimbursement of GPs who provide medical care to nursing home residents, consideration should also be given to restructuring the medical cover for nursing home residents. This would result in a greater scope for proactive and preventive interventions and for consulting with several patients during one visit.
养老院居住人数有所增加。全科医生（GPs）因老年患者的诊疗率较高而获得了更高的人头费。然而，住在养老院的老年患者与社区中的老年患者并无区别对待。
确定养老院居民是否比社区居民获得更多的全科医疗服务。
对格拉斯哥8家养老院的345名居民进行前瞻性对照研究，并设立一个年龄、性别和全科医生相匹配的社区对照小组，比例为2:1。对三个月内与初级保健机构的接触情况在频率、性质、时长和结果方面进行比较。
养老院居民与初级保健人员的总接触次数更多（P < 0.0001），与全科医生的面对面诊疗次数也更多（P < 0.0001）。他们更有可能被视为急诊（P < 0.01），但被转诊到医院的可能性并未增加，且全科医生对他们进行随访的可能性较小（P < 0.0001）。尽管与养老院居民的单次诊疗时间比与社区小组的短（P < 0.0001），但与他们诊疗的总时长更长（P < 0.001）。这相当于每年每位患者额外增加28分钟。由于61%的养老院诊疗是在与其他诊疗同一次就诊时完成的，而社区诊疗只有3%（P < 0.0001），所以部分时间会因出行时间减少而得到抵消。
我们的研究表明，与居住在社区中的同年龄、同性别的人相比，养老院居民确实需要更多的全科医疗服务。虽然可以考虑对为养老院居民提供医疗服务的全科医生给予更多经济补偿，但也应考虑调整养老院居民的医疗保障结构。这将为积极主动的预防干预以及一次就诊时为多名患者诊疗提供更大空间。
