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信息提供者AD8作为新加坡全科医生诊所认知障碍病例发现工具的初步评估:简要报告

Pilot Evaluation of the Informant AD8 as a Case-Finding Instrument for Cognitive Impairment in General Practitioner Clinics of Singapore: A Brief Report.

作者信息

Shuang Wan Esther Yee, Shaik Muhammad Amin, Adhha Amir, Hoo Ng Richard Mong, Thompson Claire, Ong Ivana, Xu Jing, Li-Hsian Chen Christopher, Dong YanHong

机构信息

Department of Pharmacology, National University of Singapore, Singapore; Memory Aging and Cognition Centre, National University Health System, Singapore.

Ar-Raudah Medical Clinic, Singapore.

出版信息

J Am Med Dir Assoc. 2016 Dec 1;17(12):1147-1150. doi: 10.1016/j.jamda.2016.07.031.

Abstract

BACKGROUND

Case-finding services using a composite total risk score (TRS) and the informant AD8 have been previously recommended to detect cognitive impairment (CI) in government subsidized primary health care centers of Singapore (ie, polyclinics).

OBJECTIVE

We compared the feasibility of implementing the services recommended for government-subsidized primary health care in private, primary health care service providers such as general practitioner (GP) clinics.

METHOD

123 patients ≥60 years of age were recruited from 2 GP clinics within Singapore. Trained research personnel administered the AD8 to informants. Patients of the present study were compared against a random sample of 123 patients selected from polyclinics.

RESULTS

Significantly higher positive screening rates (AD8 ≥3) were found among patients in polyclinics than GP clinics (P < .001). Patients attending polyclinics reported more comorbid medical issues such as subjective cognitive complaint (P < .001) and heart disease (P < .001). The TRS of patients attending polyclinics was significantly higher than those attending GP clinics (P < .001), indicating a higher proportion of patients at risk of CI in polyclinics. Therefore, patients attending polyclinics were found to have higher AD8 scores compared with patients in GP clinics (P < .001).

CONCLUSION

Compared with GP clinics, polyclinics may be more suited to provide case-finding services for the detection of CI in primary health care.

摘要

背景

此前曾推荐使用综合总风险评分(TRS)和 informant AD8 进行病例筛查服务,以在新加坡政府补贴的基层医疗中心(即综合诊疗所)检测认知障碍(CI)。

目的

我们比较了在私人基层医疗服务提供者(如全科医生(GP)诊所)中实施推荐用于政府补贴基层医疗服务的可行性。

方法

从新加坡的 2 家 GP 诊所招募了 123 名年龄≥60 岁的患者。经过培训的研究人员向 informant 发放 AD8。将本研究的患者与从综合诊疗所选出来的 123 名患者的随机样本进行比较。

结果

综合诊疗所患者的阳性筛查率(AD8≥3)显著高于 GP 诊所患者(P < .001)。到综合诊疗所就诊的患者报告了更多的合并症,如主观认知主诉(P < .001)和心脏病(P < .001)。到综合诊疗所就诊患者的 TRS 显著高于到 GP 诊所就诊的患者(P < .001),表明综合诊疗所中存在认知障碍风险的患者比例更高。因此,发现到综合诊疗所就诊的患者与 GP 诊所患者相比 AD8 得分更高(P < .001)。

结论

与 GP 诊所相比,综合诊疗所可能更适合在基层医疗中提供用于检测认知障碍的病例筛查服务。

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