Chew C A, Wilkin D, Glendinning C
Department of General Practice, University of Manchester.
Br J Gen Pract. 1994 Dec;44(389):567-70.
The 1990 contract requires general practitioners to offer all their patients aged 75 years and over an annual health check. Increasing importance is being placed on consumers' views of service provision.
A study was undertaken in June 1992 to investigate elderly patients' views and experiences of the annual health check, and to compare these with the previously reported views of general practitioners and practice nurses who had also been surveyed as part of the study.
Twenty family health services authorities wrote to a sample of 1500 elderly patients asking if the patient's name could be passed to researchers. Patients who agreed were then interviewed.
A total of 664 elderly patients (44%) were interviewed. Only 64% of respondents were aware of their entitlement to a health check. Vulnerable patients, such as those in poor health or who lived alone, were less likely to know about the health checks than other patients. Only 31% of respondents thought they had had a health check. Of these, fewer than half recalled the doctor or nurse discussing the findings with them, although 80% of doctors reported that they always or mostly discussed results with patients. Elderly patients were more likely to recall the physical aspects of the health check rather than discussion about particular health aspects. However, doctors and nurses felt that routine checks were useful for giving advice rather than detecting medical problems. Of those who had had a health check, 82% reported no improvement in their health as a result, but 93% thought that they were a good idea. Only 7% of doctors thought they were of value, compared with the majority of nurses.
It appeared that the inverse care law was operating, with those more in need of the service being less likely to have known about it. Discrepancies were found between general practitioners' and practice nurses' reports of service provision and those of elderly patients. Evidence about the cost-effectiveness of regular health checks may help the conflict between professional scepticism and consumer enthusiasm for these assessments.
1990年的合同要求全科医生为所有75岁及以上的患者提供年度健康检查。消费者对服务提供的看法正变得越来越重要。
1992年6月进行了一项研究，以调查老年患者对年度健康检查的看法和体验，并将这些与之前作为该研究一部分接受调查的全科医生和执业护士的看法进行比较。
20个家庭健康服务机构写信给1500名老年患者的样本，询问是否可以将患者姓名告知研究人员。同意的患者随后接受了访谈。
共访谈了664名老年患者（44%）。只有64%的受访者知道自己有权接受健康检查。身体虚弱的患者，如健康状况不佳或独居的患者，比其他患者更不太可能知道健康检查。只有31%的受访者认为他们接受过健康检查。在这些人中，不到一半的人回忆起医生或护士与他们讨论过检查结果，尽管80%的医生报告说他们总是或大多会与患者讨论结果。老年患者更容易回忆起健康检查的身体方面，而不是关于特定健康方面的讨论。然而，医生和护士认为常规检查对于提供建议而非发现医疗问题很有用。在接受过健康检查的人中，82%报告称健康状况没有因此得到改善，但93%认为这些检查是个好主意。与大多数护士相比，只有7%的医生认为这些检查有价值。
似乎逆向关怀法则在起作用，即那些更需要这项服务的人反而更不太可能知道它。全科医生和执业护士关于服务提供情况的报告与老年患者的报告之间存在差异。关于定期健康检查成本效益的证据可能有助于解决专业人士的怀疑与消费者对这些评估的热情之间的冲突。
