Fitzpatrick F, Harrington P, Mahony D
Strandside Medical Centre, Dungarvan Co Waterford.
Ir Med J. 2004 Apr;97(4):111-4.
The objective was to examine the impact on general practice clinical activity of the granting of medical cards to all patients over 70 years of age on 01.07.01 under the General Medical Services (GMS) scheme. Retrospective case-control study. Chart review of 50 "new GMS" patients who received medical cards on 01.07.01 compared with 50 "old GMS" patients with means tested medical cards on this date. Single-handed mixed urban/rural general practice in Ireland. 1. Attendance rates. 2. Health status as measured by total number of chronic diseases, prevalence of hypertension, diabetes and cardiovascular disease. 3. Quality of preventive care comprising influenza and pneumococcal vaccine uptake rates; hypertension control; hyperlipidaemia control; level of screening activity for hypertension, diabetes, hyperlipidaemia, prostate specific antigen (among men) and smoking behaviour. Comparisons were made both before and after free GMS care for all between the "old GMS" and "new GMS" patient groups. Behaviour of the "new GMS" group was also compared, both before and after GMS eligibility. Prior to universal eligbility "old GMS" patients attended more often (p=0.0002), had more documented chronic illness (p=0.0002), consumed more medications (p=0.0002), were more likely to be diagnosed hypertensive (p=0.0336) and to have prostate specific antigen (PSA) measurement (men only) (p=0.048) than "new GMS" patients. Within the first 6 months of free GMS care for all, the "new GMS" patients attended significantly more often than before with the percentage of high consulters increasing from 24% to 52% (p=0.0039), took more medications (from 1.72 to 2.2), showed improvement in all quality of care parameters (with the exception of PSA screening which remained static) and had improved attendance for influenza 40% to 62% (p=0.0277) and pneumococcal vaccines 2% to 26% (p=0.00054). More "new GMS" patients were diagnosed as hypertensive (24% to 38%) to a prevalence no longer significantly different from the "old GMS" group. Free general practice care has impacted positively on this "new GMS" patient group of over 70's. Our data suggests that the low consultation rate of this group when fee paying may have resulted in less exposure to practice screening activities. The apparent better health status among this group may in fact be a façade masking undiagnosed chronic disease, notably hypertension.
目的是研究根据全科医疗服务（GMS）计划于2001年7月1日向所有70岁以上患者发放医疗卡对全科医疗临床活动的影响。回顾性病例对照研究。对2001年7月1日领取医疗卡的50名“新GMS”患者的病历进行审查，并与当日接受经济状况调查医疗卡的50名“旧GMS”患者进行比较。爱尔兰城乡结合部的单人全科诊所。1. 就诊率。2. 以慢性病总数、高血压、糖尿病和心血管疾病患病率衡量的健康状况。3. 预防性护理质量，包括流感和肺炎球菌疫苗接种率；高血压控制；高脂血症控制；高血压、糖尿病、高脂血症、前列腺特异性抗原（男性）筛查活动水平和吸烟行为。对“旧GMS”和“新GMS”患者组在为所有人提供免费GMS护理前后进行了比较。还比较了“新GMS”组在符合GMS资格前后的行为。在普遍资格认定之前，“旧GMS”患者就诊更频繁（p = 0.0002），有更多记录在案的慢性病（p = 0.0002），服用更多药物（p = 0.0002），更有可能被诊断为高血压（p = 0.0336）并有前列腺特异性抗原（PSA）检测（仅限男性）（p = 0.048），比“新GMS”患者更频繁。在为所有人提供免费GMS护理的前6个月内，“新GMS”患者就诊明显比以前更频繁，高咨询者的比例从24%增加到52%（p = 0.0039），服用更多药物（从1.72增加到了2.2），所有护理质量参数均有改善（前列腺特异性抗原筛查除外，该指标保持不变），流感疫苗接种率从40%提高到62%（p = 0.0277），肺炎球菌疫苗接种率从2%提高到26%（p = 0.00054）。更多“新GMS”患者被诊断为高血压（从24%到38%），患病率与“旧GMS”组不再有显著差异。免费全科医疗护理对这个70岁以上的“新GMS”患者群体产生了积极影响。我们的数据表明，该群体在付费时咨询率较低，可能导致较少接受诊所筛查活动。该群体表面上较好的健康状况实际上可能掩盖了未被诊断的慢性病，尤其是高血压。
