Burns R, Nichols L O, Martindale-Adams J, Graney M J
Department of Preventive Medicine, University of Tennessee, Memphis, USA.
J Am Geriatr Soc. 2000 Jan;48(1):8-13. doi: 10.1111/j.1532-5415.2000.tb03021.x.
The long-term efficacy of interdisciplinary outpatient primary care Geriatric Evaluation and Management (GEM) has not been proven. This article focuses on results obtained during the 2 years of the study.
In this 2-year randomized clinical trial, at the Veterans Affairs Medical Center, Memphis, TN, 128 veterans, age 65 years and older, were randomized to outpatient GEM or usual care (UC). Two-year follow-up analyses are based on the 98 surviving individuals. Study outcome measurements included health status, function, and quality of life including affect, cognition, and mortality.
At 2 years, there were positive intervention effects for eight of 1 outcome measures, five of which had attained significance at 1 year. GEM subjects, compared with UC subjects, had significantly greater improvement in health perception (P = .001), smaller increases in numbers of clinic visits (P = .019) and instrumental activities of daily living (IADL) impairments (P = .006), improved social activity (P<.001), greater improvement in Center for Epidemiologic Studies-Depression (CES-D) scores (P = .003), general well-being (P = .001), life satisfaction (P<.001), and Mini-Mental State Exam (MMSE) scores (P = .025). There were no significant treatment effects in activities of daily living (ADL) scores (P = .386), number of hospitalizations (P = .377), or mortality (P = .155).
These findings suggest that a primary care approach that combines an initial interdisciplinary comprehensive assessment with long-term, interdisciplinary outpatient management may improve outcomes for targeted older adults significantly. Findings suggest further that outcomes may continue to improve over time and that the GEM care model provides an effective way to manage health care of older adults.
跨学科门诊初级保健老年评估与管理（GEM）的长期疗效尚未得到证实。本文重点关注研究两年期间所获得的结果。
在田纳西州孟菲斯市退伍军人事务医疗中心进行的这项为期两年的随机临床试验中，128名65岁及以上的退伍军人被随机分为接受门诊GEM或常规护理（UC）。两年的随访分析基于98名存活个体。研究结果测量包括健康状况、功能和生活质量，其中生活质量包括情感、认知和死亡率。
在两年时，11项结果测量指标中有8项出现了积极的干预效果，其中5项在1年时已达到显著水平。与UC组受试者相比，GEM组受试者在健康认知方面有显著更大的改善（P = 0.001），门诊就诊次数（P = 0.019）和日常生活工具性活动（IADL）损伤数量的增加幅度更小（P = 0.006），社交活动得到改善（P<0.001），流行病学研究中心抑郁量表（CES-D）得分（P = 0.003）、总体幸福感（P = 0.001）、生活满意度（P<0.001）和简易精神状态检查表（MMSE）得分（P = 0.025）有更大改善。在日常生活活动（ADL）得分（P = 0.386）、住院次数（P = 0.377）或死亡率（P = 0.155）方面没有显著的治疗效果。
这些发现表明，一种将初始跨学科综合评估与长期跨学科门诊管理相结合的初级保健方法可能会显著改善目标老年人群的治疗效果。研究结果进一步表明，随着时间的推移治疗效果可能会持续改善，并且GEM护理模式提供了一种管理老年人医疗保健的有效方法。
