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合并症和药物治疗对老年患者初级保健就诊频率的影响。

Effect of comorbidities and medications on frequency of primary care visits among older patients.

作者信息

Hu Tina, Dattani Neil D, Cox Kelly Anne, Au Bonnie, Xu Leo, Melady Don, Jaakkimainen Liisa, Jain Rahul, Charles Jocelyn

机构信息

Medical student, at the University of Toronto in Ontario.

Second-year family medicine resident, at the University of Toronto in Ontario.

出版信息

Can Fam Physician. 2017 Jan;63(1):45-50.

Abstract

OBJECTIVE

To determine if comorbidities and high-risk medications affect the frequency of family physician visits among older patients.

DESIGN

Retrospective chart review.

SETTING

Academic family health team at Sunnybrook Health Sciences Centre in Toronto, Ont.

PARTICIPANTS

Among patients aged 65 years and older who were registered patients of the family health team between July 1, 2013, and June 30, 2014, the 5% who visited their family physicians most frequently and the 5% who visited their family physicians least frequently were selected for the study (N = 265).

MAIN OUTCOME MEASURES

Predictors of frequent visits to family physicians.

RESULTS

The significant predictors of being a high-frequency user were female sex (odds ratio [OR] = 2.20, P = .03), age older than 85 years (OR = 5.35, P = .001), and higher total number of medications (OR = 1.49, P < .001). Age-adjusted Charlson comorbidity index score, number of Beers criteria medications, and Anticholinergic Risk Scale score were not significant predictors (P > .05).

CONCLUSION

Female sex, age older than 85, and higher total number of medications were independent significant predictors of higher frequency of family physician visits among older patients. Validated tools, such as the Charlson comorbidity index, Beers criteria, and Anticholinergic Risk Scale, did not independently predict the frequency of visits, indicating that predicting frequency of visits is likely complex.

摘要

目的

确定合并症和高风险药物是否会影响老年患者看家庭医生的频率。

设计

回顾性病历审查。

地点

安大略省多伦多市桑尼布鲁克健康科学中心的学术家庭健康团队。

参与者

在2013年7月1日至2014年6月30日期间作为家庭健康团队注册患者的65岁及以上患者中,选择看家庭医生最频繁的5%和最不频繁的5%进行研究(N = 265)。

主要观察指标

看家庭医生频繁的预测因素。

结果

高频率就诊者的显著预测因素为女性(比值比[OR]=2.20,P = .03)、年龄大于85岁(OR = 5.35,P = .001)以及药物总数较多(OR = 1.49,P < .001)。年龄调整后的查尔森合并症指数评分、符合Beers标准的药物数量以及抗胆碱能风险量表评分不是显著预测因素(P > .05)。

结论

女性、年龄大于85岁以及药物总数较多是老年患者看家庭医生频率较高的独立显著预测因素。经过验证的工具,如查尔森合并症指数、Beers标准和抗胆碱能风险量表,并不能独立预测就诊频率,这表明预测就诊频率可能很复杂。

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