Hirsch C H, Winograd C H
Division of General Medicine, University of California, Davis, School of Medicine.
West J Med. 1992 Apr;156(4):385-91.
We surveyed medical directors of primary care clinics in California to learn how those clinics cared for their frail older patients. Of 143 questionnaires sent, 127 (89%) were returned. A median of 30% of all patient encounters were with persons aged 65 or older, and a median of 20% of older patients were considered frail. A total of 20% of the clinics routinely provided house calls to homebound elderly patients. Of clinics involved in training medical students of physicians (teaching clinics), 70% had at least one physician with an interest in geriatrics, compared with 42% of nonteaching clinics (P less than .005). For frail patients, 40% of the clinics routinely performed functional assessment, while 20% routinely did an interdisciplinary evaluation. Continuing education in geriatrics emerged as a significant independent correlate of both functional assessment and interdisciplinary evaluation. Among the 94 clinics with a standard appointment length for the history and physical examination, only 11 (12%) allotted more than 60 minutes for frail patients. The data suggest that certain geriatric approaches are being incorporated into clinic-based primary care in California but do not provide insight into their content or clinical effects.
我们对加利福尼亚州初级保健诊所的医学主任进行了调查，以了解这些诊所如何照料体弱的老年患者。在发出的143份问卷中，有127份（89%）被收回。所有患者诊疗中，与65岁及以上老人的诊疗次数中位数为30%，老年患者中被认为体弱的比例中位数为20%。共有20%的诊所定期为居家的老年患者提供上门诊疗服务。在参与培训医学生或医师的诊所（教学诊所）中，70%至少有一名对老年医学感兴趣的医师，而非教学诊所的这一比例为42%（P小于0.005）。对于体弱患者，40%的诊所定期进行功能评估，而20%的诊所定期进行多学科评估。老年医学继续教育成为功能评估和多学科评估的一个显著独立相关因素。在94家对病史和体格检查有标准预约时长的诊所中，只有11家（12%）为体弱患者安排了超过60分钟的时间。数据表明，某些老年医学方法正在被纳入加利福尼亚州基于诊所的初级保健中，但并未深入了解其内容或临床效果。
