Press Yan, Punchik Boris, Kagan Ella, Barzak Alex, Freud Tamar
Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Yasski Clinic, Comprehensive Geriatric Assessment Unit, Clalit Health Services, Beer-Sheva, Israel.
Isr J Health Policy Res. 2017 Apr 25;6:7. doi: 10.1186/s13584-017-0134-7. eCollection 2017.
The overall implementation rate for outpatient comprehensive geriatric assessment (OCGAU) recommendations ranges from 48.6 to 71%. The purpose of the study was to identify factors that reduce the implementation rate of geriatric recommendations.
The medical records of patients who were assessed in the comprehensive geriatric assessment unit over an 8 year study period were surveyed. Data collected included patient's characteristics (socio-demographic, functional, cognitive, and affective condition, co-morbidity), number of recommendations, the identity of the geriatrician, and data related to the primary physician (age, sex, seniority, number of patients referred for geriatric assessment).
Three thousand four hundred thirty-four recommendations were made for 488 patients (mean age 83.6 ± 0.6 years) of which 1,634 (47.6%) were implemented by their primary physician. In univariate analyses patients with an implementation rate < 25%, compared to patients with implementation rate ≥75%, had a higher Charlson Comorbidity Index Total Score (CCITS) (2.5 ± 1.9 vs. 1.8 ± 1.7, < 0.05), a lower Barthel Index (82.8 ± 16.2 vs. 87.0 ± 15.3, < 0.05), and a lower Instrumental Activity of Daily Living score (7.2 ± 3.5 vs. 8.2 ± 3.7, < 0.05). There were no differences between these groups in other patient characteristics or the number of recommendations made during the assessment. Similarly, there were no differences in the identity of the geriatrician or the primary physician's characteristics. In the multivariate analysis only higher CCITS was associated with a lower rate of recommendation implementation by primary physicians.
There is a need to increase the implementation rate by primary physicians by increasing and strengthening the link with them and by further training in the field of geriatrics medicine.
The Helsinki committee of the Meir Medical Center approved the study (Approval #024/2015 [k]).
门诊综合老年评估（OCGAU）建议的总体实施率在48.6%至71%之间。本研究的目的是确定降低老年建议实施率的因素。
对在综合老年评估单元接受评估的患者的病历进行了为期8年的研究调查。收集的数据包括患者特征（社会人口统计学、功能、认知和情感状况、合并症）、建议数量、老年科医生的身份以及与初级医生相关的数据（年龄、性别、资历、转介至老年评估的患者数量）。
对488名患者（平均年龄83.6±0.6岁）提出了3434条建议，其中1634条（47.6%）由他们的初级医生实施。在单因素分析中，实施率<25%的患者与实施率≥75%的患者相比，Charlson合并症指数总分（CCITS）更高（2.5±1.9对1.8±1.7，<0.05），Barthel指数更低（82.8±16.2对87.0±15.3，<0.05），日常生活工具活动评分更低（7.2±3.5对8.2±3.7，<0.05）。这些组在其他患者特征或评估期间提出的建议数量方面没有差异。同样，老年科医生的身份或初级医生的特征也没有差异。在多因素分析中，只有较高的CCITS与初级医生较低的建议实施率相关。
有必要通过加强与初级医生的联系并在老年医学领域进行进一步培训来提高初级医生的实施率。
梅尔医疗中心的赫尔辛基委员会批准了该研究（批准号#024/2015[k]）。
