van Kempen Janneke A L, Melis René J F, Perry M, Schers Henk J, Rikkert Marcel G M Olde
From the Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (JALK, RJFM, MP, GMOR); Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (HJS).
J Am Board Fam Med. 2015 Mar-Apr;28(2):240-8. doi: 10.3122/jabfm.2015.02.130081.
To compare the outcomes of Comprehensive Geriatric Assessments by family physicians and geriatricians.
An explorative observational study was conducted in six family practices (12 ambulatory family practitioners) and 1 geriatric department (4 hospital-based geriatricians) from a university medical center in Nijmegen (the Netherlands). As participants, we included 587 patients aged 70 years and older and registered in the six family practices. The main outcome measures were the judgment on the following: 1) absence or presence of frailty and 2) the state (good-fair-poor) on 8 underlying domains (physical, medication, cognition, sensory, instrumental activities of daily living scale, mobility, mental, and social) according to family practitioners and geriatricians based on a Comprehensive Geriatric Assessment.
Family physicians and geriatricians agreed on frailty absence/presence in 76% of cases. Geriatricians considered elderly more often frail than family physicians did (n = 294, 50% vs n = 213, 36%). Disagreement on frailty status was notably found in the patients who had less distinct, either poor or good, health states. Discordant frailty judgments, in which the geriatrician rated a person as frail and the family physicians did not, were related to geriatricians more often rating physical health as impaired. Further, geriatricians' judgments of frailty were more strongly related to impaired scores on the domains cognition, sensory, mobility, and mental compared with family physicians judgments: odds ratios 79.3 versus 9.3, 7.6 versus 2.0, 25.0 versus 3.0, and 18.0 versus 2.2, respectively. Impaired physical health and problematic medication use had equally strong associations with frailty in geriatricians and family physicians: odds ratios of 11.5 versus 10.4 and 2.4 versus 2.5, respectively.
Geriatricians more often judge patients as frail compared with family physicians and seem to evaluate the available information differently. With increasing collaboration between primary and secondary care, understanding these differences becomes increasingly relevant.
比较家庭医生和老年病医生进行综合老年评估的结果。
在荷兰奈梅亨的一家大学医学中心的六个家庭诊所（12名门诊家庭医生）和一个老年病科（4名医院老年病医生）进行了一项探索性观察研究。作为参与者，我们纳入了在这六个家庭诊所登记的587名70岁及以上的患者。主要结局指标是对以下方面的判断：1）是否存在衰弱；2）根据家庭医生和老年病医生基于综合老年评估得出的8个基础领域（身体、用药、认知、感官、日常生活活动能力量表、活动能力、心理和社会）的状况（良好-中等-差）。
家庭医生和老年病医生在76%的病例中对是否存在衰弱达成一致。老年病医生比家庭医生更常认为老年人衰弱（n = 294，50% 对 n = 213，36%）。在健康状况不太明确（要么差要么好）的患者中，明显存在关于衰弱状态的分歧。不一致的衰弱判断，即老年病医生将一个人评定为衰弱而家庭医生不这样评定，与老年病医生更常将身体健康评定为受损有关。此外，与家庭医生的判断相比，老年病医生对衰弱的判断与认知、感官、活动能力和心理领域的受损评分的相关性更强：优势比分别为79.3对9.3、7.6对2.0、25.0对3.0和18.0对2.2。身体健康受损和用药问题在老年病医生和家庭医生中与衰弱的关联同样强烈：优势比分别为11.5对10.4和2.4对2.5。
与家庭医生相比，老年病医生更常将患者判断为衰弱，并且似乎对可用信息的评估有所不同。随着初级和二级医疗之间的合作增加，理解这些差异变得越来越重要。
