Vass M, Hendriksen C, Thomsen J L, Parner E T, Avlund K
Department of General Practice, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark.
Department of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
Eur J Ageing. 2007 Dec 21;5(1):67-76. doi: 10.1007/s10433-007-0069-x. eCollection 2008 Mar.
Preventive home visits to older home-dwelling people have been part of national policy in Denmark since 1996. The aim was to evaluate whether education of home visitors and GPs was associated with hospital admission rates. In a population-based prospective controlled intervention trial in 34 municipalities, intervention municipality visitors received regular education during 3 years and GPs were introduced to a short assessment programme. Participation totalled 4,034 75- and 80-year-old home-dwelling persons, of which 3,132 (78%) had no mobility disability at baseline. Complete data on hospital services were obtained for all participants. No difference was observed in time to first admission between older people living in the intervention municipalities compared with people living in the control municipalities, HR 0.93 (95%CI: 0.85, 1.02, = 0.17). Duration of first hospital stay was the same in the two groups (7.3 days). The mean number of admissions was not associated with intervention. Accepting and receiving home visits was associated with a reduced risk of hospital admission, HR 0.84 (95%CI: 0.76, 0.92), especially among the initially disabled. Hospital admission rates were associated with functional decline patterns. Persons experiencing catastrophic and progressive decline had the highest risk. Persons experiencing reversible functional decline were more often hospitalised in the intervention municipalities, and fewer persons living in the intervention municipalities experienced progressive decline. Education of primary care professionals was not associated with risk for first hospital admission among all older people living in the community, but may be associated with older people's different functional decline patterns.
自1996年以来，对居家老年人进行预防性家访一直是丹麦国家政策的一部分。其目的是评估家访人员和全科医生的培训是否与住院率相关。在一项针对34个市的基于人群的前瞻性对照干预试验中，干预市的家访人员在3年中接受了定期培训，全科医生也被引入了一个简短的评估项目。共有4034名75岁和80岁的居家老人参与，其中3132人（78%）在基线时没有行动障碍。获取了所有参与者完整的医院服务数据。与对照组相比，干预组的老年人首次入院时间没有差异，风险比为0.93（95%置信区间：0.85, 1.02，P = 0.17）。两组首次住院时间相同（7.3天）。平均住院次数与干预无关。接受家访与住院风险降低相关，风险比为0.84（95%置信区间：0.76, 0.92），尤其是在最初有残疾的人群中。住院率与功能衰退模式相关。经历灾难性和进行性衰退的人风险最高。经历可逆性功能衰退的人在干预市住院的频率更高，干预市中经历进行性衰退的人更少。对基层医疗专业人员的培训与社区中所有老年人首次住院的风险无关，但可能与老年人不同的功能衰退模式有关。
