痴呆症护理：一项基于人群的研究，调查符合指南的医疗护理的差异。

Caring for dementia: a population-based study examining variations in guideline-consistent medical care.

机构信息

UBC Centre for Health Services and Policy Research, School of Population and Public Health, Vancouver, BC, Canada.

出版信息

Alzheimers Dement. 2015 Aug;11(8):906-16. doi: 10.1016/j.jalz.2015.02.008. Epub 2015 May 5.

DOI:10.1016/j.jalz.2015.02.008

PMID:25956989

Abstract

BACKGROUND

Evidence indicates that early detection and management of dementia care can improve outcomes. We assess variations in dementia care based on processes outlined in clinical guidelines by the BC Ministry of Health.

METHOD

A population-based retrospective cohort study of community-dwelling seniors using patient-level administrative data in British Columbia, Canada. Guidelines measured: laboratory testing, imaging, prescriptions, complete examination, counseling, and specialist referral.

RESULTS

Older patients were less likely to receive guideline-consistent medical care. Patients in higher income categories had higher odds of receiving counseling (confidence interval or CI 1.13-153) and referrals (15.1 CI 1.18-1.95) compared with those of lower income. Over a quarter of the cohort received an antipsychotic (28%) or nonrecommended benzodiazepine (26%). Individuals living within "rural" health authorities or of low income were more likely to receive antipsychotic treatment.

CONCLUSION

Patterns of inequality by age and income may signal barriers to care, particularly for management of dementia care processes.

摘要

背景

有证据表明，早期发现和管理痴呆症护理可以改善预后。我们根据不列颠哥伦比亚省卫生部临床指南中概述的流程来评估痴呆症护理的差异。

方法

这是一项基于人群的回顾性队列研究，使用加拿大不列颠哥伦比亚省的患者级别的行政数据，研究对象为居住在社区的老年人。指南衡量了实验室检测、影像学、处方、全面检查、咨询和专家转诊等方面。

结果

年龄较大的患者接受符合指南的医疗护理的可能性较低。与收入较低的患者相比，收入较高的患者接受咨询（置信区间或 CI 1.13-153）和转诊（15.1 CI 1.18-1.95）的可能性更高。超过四分之一的患者接受了抗精神病药物（28%）或不推荐的苯二氮䓬类药物（26%）治疗。居住在“农村”卫生当局或收入较低的个体更有可能接受抗精神病药物治疗。