Iliffe S, Mitchley S, Gould M, Haines A
Department of Primary Health Care, University College London Medical School.
Br J Gen Pract. 1994 Nov;44(388):503-7.
Use of brief screening instruments for detection of psychological morbidity among elderly people is being promoted, although the appropriateness and effectiveness of available instruments have not been evaluated in general practice.
This study set out to determine the outcome of opportunistic use of brief screening instruments for dementia, depression and problem drinking in randomized trials in two group practices in north west London.
Screening instruments were inserted into a random sample of medical records for people aged 75 years and over in each practice. Medical records of those seen by their general practitioners over a six month period were reviewed for new diagnoses of dementia (or confusion), depression or problem drinking, and the scores obtained on screening instruments noted. The records of all those identified as possibly demented, depressed or drinking heavily were reviewed one year after screening and all relevant referrals and new treatments were noted.
In one practice use of screening instruments resulted in a significant increase in the detection of possible dementia, but not of depression. In the second practice screening instruments yielded significantly higher numbers with possible dementia or depression. Heavy drinking was uncommon in either population. There was no difference in the proportions of cases identified by screening instrument or by clinical judgement alone who received treatment or referral.
These results suggest that in the absence of agreed guidelines and resources, information derived from screening instruments may not alter clinical practice.
尽管现有工具的适用性和有效性在一般医疗实践中尚未得到评估，但目前正在推广使用简短筛查工具来检测老年人的心理疾病。
本研究旨在确定在伦敦西北部的两组医疗实践中，随机试验中机会性使用简短筛查工具来检测痴呆、抑郁和问题饮酒的结果。
在每个医疗实践中，将筛查工具随机插入到75岁及以上人群的医疗记录样本中。回顾了在六个月期间其全科医生看过的人的医疗记录，以查看痴呆（或意识模糊）、抑郁或问题饮酒的新诊断情况，并记录筛查工具上获得的分数。在筛查一年后，对所有被确定可能患有痴呆、抑郁或酗酒的人的记录进行了回顾，并记录了所有相关的转诊和新治疗情况。
在一个医疗实践中，使用筛查工具使可能痴呆的检出率显著增加，但抑郁的检出率没有增加。在第二个医疗实践中，筛查工具使可能患有痴呆或抑郁的人数显著增加。酗酒在这两个人群中都不常见。通过筛查工具或仅通过临床判断确定的接受治疗或转诊的病例比例没有差异。
这些结果表明，在缺乏商定的指南和资源的情况下，从筛查工具中获得的信息可能不会改变临床实践。
